Instagram

What to Expect

Please fill out this form, and I will send you your treatment plan within 3-7 days. After submitting, you'll be redirected to subscribe to the Virtual Client Program ($25/month).

Virtual Client Type

You can change this later!

What type of virtual client would you like to be? *

ASYNCHRONOUS

You prefer to connect only through email, our secure client portal, or text messages. There are no live video or phone calls, and everything is done at your own pace.

SYNCHRONOUS

You want scheduled, face-to-face time. You can choose Google Meet sessions, which incur a small fee for each meeting, or biweekly phone check-ins.

BOTH

You decide each month or before your biweekly check-in whether you would like to meet live or keep everything online through email, the portal, or text.

Your Skin Concerns

Select all that apply

Skincare Routine

List your skincare routine & brands (Cleanser, Toner, Hydrator, Moisturizer, Facial Oil, Exfoliants, Serums, etc.) *

Please upload a photo of your current home care products

Upload a clear photo of your products so I can review ingredients and usage.

Photos of Your Skin

Must be in natural lighting (include at least 1 of each: right profile, left profile, front facing, close up of areas of concern)

Upload Photos of Your Skin *

Photos in natural lighting help me give the most accurate recommendations.

Medical History

Do you have any of the following conditions? If yes, please select them.

Your Lifestyle

What is your occupation:

What is your sun exposure?

Do you use sun protection (sunscreen, hats, protective clothing)?

Yes

Do you use tanning beds?

Yes

Do you smoke?

Yes

Do you drink more than 4 caffeinated beverages a day?

Yes

What is your alcohol consumption?

Your Skin Type

Your Skin Type *

Your Skin History

Budget

What is your preferred budget for your skincare routine? *

Under $180

$181–$400

No budget

Full routines typically start at an estimated cost of $180 or more. Please select the option that best fits your comfort level.

Agreement

I have read and completed this questionnaire truthfully. I understand that withholding information or providing inaccurate details about my medical history, allergies, medications, and skincare routines may lead to contraindications or adverse reactions to the treatments I undergo. I agree to inform the technician of any changes in the above information. *

Contact Details

First name *

Last name *

Today's Date *

Month

Day *

Year *

Email *

Phone *

Yes, subscribe me to your newsletter.

Virtual Client Program — $25/month

After submitting your intake form you'll be redirected to Stripe to start your subscription. You can cancel anytime.

Skin Alchemy HI

AI Assistant

Aloha! I'm Skin Alchemy HI's virtual assistant. I can help with questions about our services, pricing, booking, location, and more. How can I help you today?

What to Expect

Please fill out this form, and I will send you your treatment plan within 3-7 days. After submitting, you'll be redirected to subscribe to the Virtual Client Program ($25/month).

Virtual Client Type

You can change this later!

What type of virtual client would you like to be? *

ASYNCHRONOUS

You prefer to connect only through email, our secure client portal, or text messages. There are no live video or phone calls, and everything is done at your own pace.

SYNCHRONOUS

You want scheduled, face-to-face time. You can choose Google Meet sessions, which incur a small fee for each meeting, or biweekly phone check-ins.

BOTH

You decide each month or before your biweekly check-in whether you would like to meet live or keep everything online through email, the portal, or text.

Your Skin Concerns

Select all that apply

Skincare Routine

List your skincare routine & brands (Cleanser, Toner, Hydrator, Moisturizer, Facial Oil, Exfoliants, Serums, etc.) *

Please upload a photo of your current home care products

Upload a clear photo of your products so I can review ingredients and usage.

Photos of Your Skin

Must be in natural lighting (include at least 1 of each: right profile, left profile, front facing, close up of areas of concern)

Upload Photos of Your Skin *

Photos in natural lighting help me give the most accurate recommendations.

Medical History

Do you have any of the following conditions? If yes, please select them.

Your Lifestyle

What is your occupation:

What is your sun exposure?

Do you use sun protection (sunscreen, hats, protective clothing)?

Yes

Do you use tanning beds?

Yes

Do you smoke?

Yes

Do you drink more than 4 caffeinated beverages a day?

Yes

What is your alcohol consumption?

Your Skin Type

Your Skin Type *

Your Skin History

Budget

What is your preferred budget for your skincare routine? *

Under $180

$181–$400

No budget

Full routines typically start at an estimated cost of $180 or more. Please select the option that best fits your comfort level.

Agreement

Contact Details

First name *

Last name *

Today's Date *

Month

Day *

Year *

Email *

Phone *

Yes, subscribe me to your newsletter.

Virtual Client Program — $25/month

After submitting your intake form you'll be redirected to Stripe to start your subscription. You can cancel anytime.

Skin Alchemy HI

Virtual Client Intake Form

Skin Alchemy HI

Virtual Client Intake Form