top of page

Facial clients, please fill out the form below and submit it before your scheduled appointment.

Facial Intake Form
What are you looking for in a facial?
Massage Pressure:
Please check your areas of concern:
Do you consume a lot of processed food?
What kind of water do you drink?
Check all that apply to you:

Home Skin Care
Check the steps that apply and provide the product if possible. 

Check all that apply:
Check all that apply:
Check all that apply:
Check all that apply:
Check all that apply RECENTLY:

I understand that aesthetic services offered are not a substitute for medical care. I understand that the information provided is to aid the esthetician in providing a better service and is completely confidential. Failure to inform the esthetician of any conditions could result in unfavorable outcomes. As with all skin treatments, there is no guarantee of results. Depending on the treatment(s), I may experience some temporary mild discomfort such as soreness, stinging, warm flushing or redness. Adequate water consumption is critical as well as following a home regimen recommended by your esthetician.

I fully understand and agree to the above policies. I have filled out the skin care intake form correctly and accurately. I hereby give my consent to receive spa treatments and release Bellatrix Beauty LLC and esthetician Jenna Plastic from any claims (implied or stated) that I have or may have in the future with this or any other treatment, regardless of the results. I am stating that I understand the treatments I am to receive and possible side effects that may occur.

Thanks for submitting!

bottom of page