Honeyed Essentials

Client Intake Form

Welcome, beautiful! Please take a moment to complete this form so we can tailor your experience and provide the best care possible. Your comfort, safety, and results are our top priorities.

First name

Last name

Phone

Birthday

Month

Day

Year

How Did You Hear About Us?

Emergency Contact Name

Emergency Contact Number

Lifestyle

Daily water intake?

Plenty

Moderate

Not enough

Physical activity?

Very active

Lightly active

Not active

Occupation

Health

Are you currently receiving medication or treatment for any conditions?

Yes

Other

Please explain (ex. type of medication, date of your last treatment, etc.)

Do you have any allergies or sensitivities?

Skin History

Have you received Botox, fillers, or any cosmetic injectables in the last 14 days?

Are you currently under the care of a dermatologist or physician for any skin condition?

Do you have a current skincare routine?

Yes

Somewhat

Please describe your current routine

Have you ever had a facial before? If yes, what was your favorite part?

Body & Wellness Check-In

How often do you do self-care?

All the time

Often

Rarely

What are you current stress levels?

High Stress

Moderate Stress

Low Stress

ADVANCED TREATMENTS:

During your appointment, I may recommend advanced treatments based on your skin’s needs. These treatments are optional and will always be explained before being performed. Pricing is listed below for transparency.

Enzyme Treatment — $15
High Frequency — $15
Oxygen Infusion — $20
Microdermabrasion — $35

Optional Comfort Add-ons

These treatments are optional and will always be explained before being performed. Pricing is listed below for transparency.

Scalp Ritual — $15
Extended Massage — $25
Gua Sha — $15
Brow Cleanup — $5
Lip Treatment — $8

Consent & Waiver

*ClassPass Clients:

We are delighted to welcome clients from booking platforms like ClassPass. Please note that these platforms charge a significant commission, which reduces our payment for the service rendered. To ensure we can continue to provide the same high-quality experience to all our clients, a service fee of $25 is applied to facial appointments booked through ClassPass.

Emails and Text Messaging

Join our email and SMS thread for updates on appointments, sales, and new updates with Honeyed Essentials!

Please read and check each box below

I understand that facial treatments have potential risks including redness, sensitivity, irritation, or breakouts.
I have disclosed all known allergies, medications, and conditions that may affect today’s service.
I understand results may vary and that no guarantees are made.
I agree to communicate openly and ask questions if I have concerns at any point during my service.
I understand that advanced treatments may be recommended during my appointment and I consent to their addition only after they are explained to me during service.
I release Honeyed Essentials, its owners, members, and employees from any liability related to my service.
I understand and consent that by checking this box, I acknowledge that I have read, understood, and agree to the terms above. I understand that checking this box serves as my legal digital signature and consent to receive services from Honeyed Essentials.

I agree to the terms and conditions above and consent to receive treatment.

Honeyed Essentials

Client Intake Form

Honeyed Essentials

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