Name *

First Name

Last Name

I am *

NEW CLIENT

RETURNING CLIENT

I would like to *

SCHEDULE a NEW Appointment

RE-SCHEDULE an EXISTING Appointment

CANCEL my Appointment

I would like this SERVICE *

Classic European Facial for WOMEN = $150

Classic European Facial for MEN = $150

Basic Consult WITHOUT Facial = $30

I would like to ADD-ON following treatment(s) *

Extractions (add-on) = $30

Lift & Firm Mask (add-on) = $20

Eye Treatment (add-on) = $30

Stem Cells Serum & Mask (add-on) = $30

Chocolate Scrub & Mask (add-on) = $30

Radiance Peel (add-on) = $30

Oxygen Therapy (add-on) = $30

LED Light Therapy (add-on) = $50

Ultrasonic Therapy (add-on) = $50

Galvanic Therapy (add-on) = $50

I DON'T KNOW - I am open to recommendation

My main skin CONCERNS are: *

Acne | Blackheads | Congestion

Rosacea | Sensitivity | Eczema

Dryness | Dehydration

Wrinkles | Fine Lines

Saggy Skin | Lost Elasticity

Scars | Rough Texture

Sun Damage | Dark Spots

Eye Wrinkles | Puffiness | Dark Circles

Dry Lips

Phone *

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Preferred Day *

MM

DD

YYYY

Preferred Time *

Hour

Minute

Second

AM PM

How did you hear about SkinGlow Salon? *

REGENCY Salon Studios

JACKALOPE ART FESTIVAL

YELP

GOOGLE

FRIEND

I HAVE A GIFT CERTIFICATE