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: A $100 non-refundable consultation fee is required. This fee may be applied toward future treatments if used within 3 months. A $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 appointment, as well as no-shows, will result in forfeiture of the deposit. A new deposit will be required to schedule another appointment. 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