Your name

Your email

Your Phone

Do you have any plant, food or nut allergies?
YesNo

If Yes, please list:

Are you under the care of a doctor for a current condition?
YesNo

If you are under the care of a doctor, please list any skin, autoimmune, or circulation conditions.

Are you pregnant?
YesNo

If yes, how many weeks?

I understand that withholding information or providing misinformation may result in contraindications, and or irritation to my skin from the facial massage received. The facial massage I receive here is voluntary and I release Stepping Into Wellness, LLC and The Registry Las Olas from liability and assume full responsibility thereof.

Sign Me Up