MedspaPCF005 Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Customer DetailsEmail *This will be used to identify your order and send you the final product. =Page 1Would you like to add a logo? *YesNoHow will you provide the logo to me?I have a file/filesI can provide a link to the logoI can provide a link to a page with the logo on it* Please note that providing a file is preferred. This usually results in a higher quality image.**If you have multiple files of the same logo, but are unsure of which one provides the best quality, you can just upload them all.File Upload Click or drag files to this area to upload. You can upload up to 10 files. Accepted file types: .svg, .png, .jpg, .pdf, .eps, .tiff, .ai, .psdPaste the link to your logo here.Would you like your logo to link to a web page? *YesNoPlease provide the web page address your logo should link to.Example: https://www.460sjournal.comWould you like to add a business address or location? *YesNoPlease enter the business address or location.Please include your business name as it should be presented on the form. ***Please use this image to answer the following questions.*** The image above contains default text. Would you like to change any of the italicized text? *Yes (explain)No, I’ll stick with the default.Please note: Your clients will be **required** to complete the following fields: 1. First Name 2. Last Name 3. Referred by / Found throughPlease describe the changes you would like to make.Please type your name exactly as you would like it to appear next to "Provider Name" on the form. *If you would like to identify your pronouns to your clients, please type them here exactly as you want them to appear next to "Pronouns" on the form.If no pronouns are provided, this field will be removed from your form. ***Please use this image to answer the following questions.*** The image above contains default text. Would you like to make any adjustments to the "Guest Pronoun" options? *Yes (explain)No, I’ll stick with the default.Please describe the changes you would like to make. ***Please use this image to answer the following questions.*** When your client marks "Yes" a list of services appear. Would you like to make any changes? *Yes (explain)No, I’ll stick with the default.Please describe the changes you would like to make. ***Please use this image to answer the following questions.*** The questions above prompt your client to select a number on a scale. Would you like to make any changes to those questions? *Yes (explain)No, I’ll stick with the default.Please describe the changes you would like to make.Page 2 ***Please use this image to answer the following questions.*** Would you like to change any of the "Skin Type" options? *Yes (explain)No, I’ll stick with the default.Please describe the changes you would like to make. ***Please use this image to answer the following questions.*** Would you like to change any of the questions? You may also add or subtract questions. *Yes (explain)No, I’ll stick with the default.Questions 2, 4, and 6 are “Yes/No” selections. Questions 1, 3, and 5 allow your client to write or type out an answer.Please describe the changes you would like to make. ***Please use this image to answer the following questions.*** Would you like to change any of the "Current Products Used"? You may also add or subtract from the list. *Yes (explain)No, I’ll stick with the default.**Note: The ability for your clients to describe the “type” is only available if they check the box next to each product they use.Please describe the changes you would like to make. ***Please use this image to answer the following questions.*** Would you like to change any of the "Prior Aesthetic/Cosmetic Treatments"? You may also add or subtract from the list. *Yes (explain)No, I’ll stick with the default.**Note: The ability for your clients to add additional details is only available if they check the box next to each prior treatment.Please describe the changes you would like to make. Page 3 ***Please use this image to answer the following questions.*** Would you like to make any changes to Area 1 list of concerns or follow-up questions? *Yes (explain)No, I’ll stick with the default.**Note: The list of concerns and follow-up questions only become available to the client if they select “Yes”.Please describe the changes you would like to make. ***Please use this image to answer the following questions.*** Would you like to make any changes to Area 2 list of concerns or follow-up questions? *Yes (explain)No, I’ll stick with the default.**Note: The list of concerns and follow-up questions only become available to the client if they select “Yes”.Please describe the changes you would like to make.Page 4 ***Please use this image to answer the following questions.*** Would you like to make any changes to Area 3 list of concerns or follow-up questions? *Yes (explain)No, I’ll stick with the default.**Note: The list of concerns and follow-up questions only become available to the client if they select “Yes”.Please describe the changes you would like to make. ***Please use this image to answer the following questions.*** Would you like to make any changes to Area 4 list of concerns or follow-up questions? *Yes (explain)No, I’ll stick with the default.**Note: The list of concerns and follow-up questions only become available to the client if they select “Yes”.Please describe the changes you would like to make.Page 5 ***Please use this image to answer the following questions.*** Would you like to make any changes to Area 5 list of concerns or follow-up questions? *Yes (explain)No, I’ll stick with the default.**Note: The list of concerns and follow-up questions only become available to the client if they select “Yes”.Please describe the changes you would like to make. ***Please use this image to answer the following questions.*** Would you like to make any changes to Area 6 list of concerns or follow-up questions? *Yes (explain)No, I’ll stick with the default.**Note: The list of concerns and follow-up questions only become available to the client if they select “Yes”.Please describe the changes you would like to make. Page 6 ***Please use this image to answer the following questions.*** Would you like to make changes to any of the text on this page? *Yes (explain)No, I’ll stick with the default.**Note: Your client will be required to provide the following information: 1. Signature 2. DatePlease describe the changes you would like to make. Page 7 ***Please use this image to answer the following questions.*** Would you like to make changes to any of the text on this page? This includes the handwritten note at the end. *Yes (explain)No, I’ll stick with the default.**Note: ALL text can be changed, including the “handwritten note” at the end. **Clients will click the submit button to automatically return this form to you via email.Please describe the changes you would like to make. How much time in advance of your appointment would you like your client to return this form? *Please provide the email address where you would like to receive this form. *Final NotesThank you again for choosing to work with me. Please allow me up to 48 hours to build and deliver your custom form. Meanwhile, please watch your Etsy messages and email for any communications from me. If you would like to explore additional services I provide, please remember to visit my website: www.460sjournal.com AFTER you submit this form 🙂 Talk soon, ~ Mel Submit
