New Client Request Form Full Name *Date of Birth *Email Address *Phone *Appointment DetailsWhat are your primary concerns? (Check all that apply) *Fine Lines & WrinklesSkin Laxity / SaggingUnder Eye hollowness, discoloration, fine linesEnlarged PoresDry, dull skinSkin Texture & ToneVolume LossPigmentation / Uneven ToneDouble ChinAcne or Acne ScarringHair Loss / ThinningThinning LipsOtherIf you Selected (Other) in your primary concerns please describe hereWhat are your aesthetic goals *Ready to start a committed aesthetic journey to age gracefullyLooking for a one-time treatment for an event.Ready to start a daily skincare ritualHave you received any aesthetic treatments in the past 6 months (e.g., Botox, fillers, lasers, RF)? *YesNoIf you Selected Yes please listAre you currently pregnant or breastfeeding? *YesNoDo you have any relevant medical conditions or allergies? *YesNoIf you Selected Yes please listPreferred Appointment Date(s) *We are open: Tuesday & Wednesday from 10:00 AM – 2:00 PM *Thursday & Friday from 10:00 AM – 7:00 PM *Saturday from 10:00 AM – 2:00 PMPreferred Time *10:00 AM - 12:00 PM12:00 - 2:00 PM2:00 - 4:00 PM4:00-6:00 PMConsent *Confirm that you agree to our terms of service and cancellation policy by checking this box.Acknowledgement & Consent By submitting this form, I acknowledge and agree to the following terms: *By submitting this form, I acknowledge and agree to the following terms: By submitting this form, I acknowledge and agree to the following terms: $100 non-refundable consultation fee is required. This fee may be applied toward treatments or packages purchased on the same day. $100 treatment deposit is required for each booked service. Reveal KBeauty Med Spa enforces a 48-hour cancellation policy.Cancellations made within 48 hours of the scheduled appointment, as well as no-shows, will result in forfeiture of the deposit.A new deposit will be required to reschedule. The deposit will be refunded upon completion of the scheduled treatment. Appointments are not considered confirmed until a confirmation text is received from Reveal KBeauty Med Spa. All information provided is accurate to the best of my knowledge and will be kept strictly confidential.Submit appointment Request