Appointment

Please complete the form, and I’ll be in touch with you shortly.

Kindly note that submitting this form does not guarantee an appointment until you receive personal confirmation from me.

Important: If you haven’t heard back within a week, feel free to reach out via text at (347) 885-8883.

Name

First Name

Last Name

Pronouns

Phone

(###)

###

####

Preferred Appointment Time

Morning Weekday (9 am to 11:30am)

Afternoon Weekday (12pm to 4pm)

Saturday (9am to 3pm)

Flexible

Contact Preference

Select one

Skin Treatments

Facial Booster (add on) can be added during your actual appointment.

Credit Card Number

A valid credit card required to book and hold appointment.

Expiration Date

For the day you can input any number.

YYYY

CCV Number

Billing Zipcode

Billing zip code of credit card.

Enter Name for Electronic Signature

I understand that any cancellations or rescheduling must be made at least 24 hours in advance. If I cancel, reschedule with less than 24 hours’ notice, or do not show up for my appointment, I acknowledge that the full amount of the skin treatment I booked will be charged to the card on file. I also understand that all service prices listed reflect starting rates and may increase based on any Add-On(s).