Appointment

Please fill out this form and I will be in contact with you shortly. Submitting this form does not guarantee your appointment until I confirm with you personally.

ATTENTION: If you do not receive a reply from me after a week please contact me directly via text message to (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 agree and understand that any cancellations or rescheduling must be made a minimum of 24 hours prior to my appointment. If a cancellation or rescheduling is made with less than 24 hours notice, or I do not show up for my appointment, I acknowledge that the card on file will be charged a full amount of the skin treatment I selected. I agree and understand that all services show a starting price and can increase if I choose to select Add On(s) during my appointment.