New Client Intake Form

Welcome to Offgrid Skin. My client results are my highest priority. To ensure that we are setting on the right path together, we will always start with a consultation. Please fill out the form below, once you have submitted it you will be taken to a page where you can book your first appointment.

FIRST NAME

LAST NAME

email address

PHONE

How old are you?

Where Does Your Skin Breakout The Most?

What is Your Biggest Skin Concern?

How much water do you intake regularly?

How Have You Tried To Deal With Your Skin Concern So Far?

Do you have a skincare routine that you practice?

Are you currently taking:

If other, please list

Have you received any Botox, Juvederm, or other dermal fillers in the last two weeks?

What are Your Current Products

How much time do you usually spend on your skincare routine?

Do you have any of the following:

If you have other Conditions, please list

Please list any known allergies to cosmetics, food or drugs

Are you pregnant, or planning to become pregnant? If yes, when is your due date?

Please upload your pictures here

What would you like to gain from your experience with me? I LOOK FORWARD TO OUR SKIN JOURNEY!

Preferred Method of Consultation

New Client Intake Form

Booking Your First Treatment

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