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Simply Charisma Beaute Boutique

specializing in skin care and body treatments

About Us
The Charismatic Experience
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Client Intake Form

First Name

Email Address

Last Name

Date of Birth

Are you experiencing skin irritation? *

No

Yes

Are you allergic to any foods, chemicals, or other substances? *

No

Yes

If you answered yes to any question, please elaborate

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

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