Client Form General Information Name * First Name Last Name Email * Phone * (###) ### #### Date of Birth * MM DD YYYY Emergency Contact Information Emergency Contact * First Name Last Name Phone * (###) ### #### Emergency contact’s relationship to you * Health Information Please briefly describe what you need help with * Services you might be interested in: * (Please note: Not all services shown below are listed on my website, please speak to Tamara for more information. Skin Blemish Removal (e.g. skin tags) Electrolysis Facials Waxing Brows & Lashes Sports Massage Aromatherapy Reflexology Indian Head / Scalp Massage Healthy Lifestyle Support (Exercise, Nutrition, Health) Courses & Programs How did you find me? * Referral / Recommendation Word of Mouth Social Media Google Salon Clients are automatically added to communication channels Opt out Thank you!
