Please take a moment to fill out our intake form. Thank you!

Name *
Phone Number *
Phone Number
Emergency Contact *
Emergency Contact
Complexion *
Pore Size *
Skin Texture *
Sleep Patterns *
Digestion *
Mind *
Emotions *
Under Stress *
Hair Type *
What areas of concern do you have pertaining to your skin? *
Allergies *
Are you allergic to any of the following?
I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received. The treatments I receive here are voluntary and I release this skin care professional, Jen Stoeckert | Minimal Beauty Studio from liability and assume full responsibility thereof for current and future treatments.