Test Name* First Last Email* Phone*Service*Prices are subject to change.Eyebrow Shaping WaxLip WaxChin WaxForehead WaxUnderarm WaxHalf Arm WaxUnderarm & Half ArmBikiniBrazilianHalf Leg WaxFull Leg WaxHalf Leg & BikiniHalf Leg & BrazilianShoulder WaxChest WaxBack WaxOpti-Firm Eye TreatmentOne-Shot Lash LiftingEyebrow TintingEyelash TintingEnzymatic Micro PeelBiolight Glyco-Sea Glycolic PeelMicrodermabrasion with Lamina lift maskDate*Please indicate the date on which you'd like to book your service. Please note, this does not confirm your reservation. Date Format: MM slash DD slash YYYY Time*Please indicate at which time you'd like to book your service. Please note, this does not confirm your reservation. : HH MM AM PM Special RequestsPlease indicate any allergies or sensitivities to products or any other special requests.Total $0.00 Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name
