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Esthetics- Client Intake Questions

1. Name:

2. Birthdate:

3. Email address:

4. Phone number:

5. Preferred method of contact?

6. Best time to reach you?

7. Building name or address?

8. Does your building have a massage or beauty room? (If not our service providers will plan to do the service in-unit)

9. What aspects of your skin would you like to address with your service?

Acne
Congestion or blackheads
Unwanted facial hair
Unwanted body hair
Aging, fine lines and wrinkles
Pigment concerns
Dryness
Oiliness
Overall complexion
Skin condition - Write In (Required) Please enter an 'other' value for this selection. * This question is required.
Other - Write In (Required) Please enter an 'other' value for this selection. * This question is required.

10. Please mark your desired service(s)

Enzyme Facial: exfoliation, extractions, serums, masques
Deep Detox Facial: deep cleanse, extractions, healing serums and masques
Special Treatment Facial: Microdermabrasion, Chemical Peal
Custom Skin Therapies for aging, acne or pigment concerns
Hair Removal- Waxing
Body Scrub Polish
Brow Shape and Tint
Eyelash Lift and Tint
Facial Massage
Manicure
Unsure-- Have a LulaFit Esthetician customize your treatment
Other - Write In Please enter an 'other' value for this selection.

11. If possible, please upload a clear photo of your skin without makeup on.

File: {{filename}} delete

12. Do you have any current or past injuries pertaining to your skin or area of treatment?

Please elaborate:

13. Do you have a day that you would like to schedule a skin care service in mind?

If yes, please select a date. Please note: we require 48-72 hours advance notice for beauty service bookings and this survey does NOT confirm your appointment. You will receive an email to finish booking your massage.

This question requires a valid date format of MM/DD/YYYY.

calendar

What time?

If not what is your general availability for skin treatments?

14. Is there anything else you would like LulaFit's licensed esthetician to know prior to your skin care service?