Intake Form

Please fill out the new client intake form, this will speed up the process on your first visit with us. Once completed, a SKN Clinic Manager will contact you with availability options for your in-person consultation. We look forward to seeing you soon!

Personal Information

We do not share contact info with any 3rd parties. Opting in to our newsletter means you'll receive approximately 12-15 emails from us per year with specials, prizes and information.

NOTE: Please be sure to check your junkmail if you have not received a response from us via email within 24hrs during business days.

Are you 18 or older? *

Sorry, we are unable to treat clients under the age of 18 at this time.


Client Expectations

Medical History

(Check all that apply)

UV / Sun Exposure

Treatment History

Check all that apply

Skin care

Lifestyle & Diet

Please Review & Agree

I have read and will follow to the best of my abilities any and all instructions. I will let my practitioner know if I start any new medications, skin care products, become pregnant or have undergone any treatments at other facilities that could possibly affect the outcome of my treatment program at SKN Holistic Rejuvenation Clinic:


Once we have confirmed your appointment, we require a minimum of 24hrs notice before your appointment time for cancellations or changes for appointments up to 60 minutes in length. For appointments longer than 60 minutes, we require 48hrs.

Failure to provide adequate notice, or no-showing, will result in a $50 late cancellation fee and no-shows will also be required to pay in full in advance to re-book.

All new clients must provide a credit card number to book their first appointment. Also, clients booking multiple appointments (for themselves and a friend) will be required to provide a credit card to hold their spots.