Start Your Journey

Please complete this confidential questionnaire form to guide you to what service or tier package is the best for you and receive a link for a complimentary consultation with Miki.

Together we will create a skin care protocol to bring about YOUR radiant wellness.

Your Perfect Package

To help determine which service or tier package is best for you, please complete this confidential questionnaire form.

Upon completion, you will receive a link for a complimentary consultation call with Miki.

Together, we will create a skincare protocol to bring about YOUR radiant wellness.

Name

First Name

Last Name

Phone

(###)

###

####

When you look in the mirror, what do you see that you would like to change or that bothers you?

Do you have spots?

If yes, what kind of spots?

How does your skin feel to you?

Dry and rough? Bumpy? Soft and smooth?

How do you see your skin?

Dull? Drab? Lines and wrinkles?

Have you had professional treatments in the past?

Yes

If yes, what was your experience when having had professional treatments?

What services are you interested in?

Click all that apply

Facial Treatment

Hair Reduction

Acne Treatment

Brow or Lash Tinting

Do you have a time frame to meet your skin care goals?

What is your budget?

Preferred Date

YYYY

How did you hear about us?