Patient Forms

Patient Forms 2017-08-07T17:14:02+00:00
RESTORE BEAUTY AESTHETIC PATIENT INTAKE FORM

Thank you for scheduling an appointment with us. Please take 5-10 minutes to complete the form below and submit it it to us at least 48 hours prior to your appointment. It will assist us to provide you with the best patient experience. Please feel free to contact us with any questions.

We look forward to seeing you at your appointment!

MEDICAL HISTORY

SKIN CARE REGIMEN

CAPTCHA
RESTORE BEAUTY RESERVATIONS & CANCELLATION POLICIES: Services are available by appointment. Upon booking, clients will be asked to use a credit card to guarantee the reservation. We will be unable to book your appointment without a credit card guarantee. Please keep in mind that payment is due at the time of service, we do not accept any form of insurance. A valid credit card is required to hold an appointment at RESTORE BEAUTY. RESTORE BEAUTY has a 24-hour cancellation policy. A $50 fee per appointment booked will be charged to the credit card on file for missed appointments not cancelled or re-scheduled at least 24 hours in advance. If you miss a pre-paid package appointment, we will charge $50 fee to the credit card on file. Missing or cancelling multiple appointments may be subject to more penalty fees.
The information on this form is correct to the best of my knowledge. I have read and understand the Appointment Cancellation Policy of the practice and I agree to be bound by its terms. I also understand and agree that such terms may be amended from time-to-time by the practice.
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