New Patient Check-In
Welcome. Let's get you started.
Tell us a little about yourself so we can personalize your experience.
Medical History
This information helps us provide the safest, most effective treatments for you.
Today's Visit
Tell us what brings you in today.
Consent & Agreements
Please read carefully and check each box to confirm your understanding.
I have read and understand the informed consent for aesthetic treatments and voluntarily agree to proceed.
I acknowledge receipt of the HIPAA Privacy Notice and consent to the collection and use of my health information for treatment purposes.
I consent to before/after photographs for my clinical record. (Optional — uncheck to decline)
I confirm that all information I have provided is accurate and complete to the best of my knowledge.
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By signing above, I confirm that I am the patient named in this form (or their authorized guardian), that I have read all pages of this intake form, and that I agree to the terms described herein.
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Your intake form has been submitted and saved to your patient record. A member of our team will be with you shortly.
Your intake summary
Good morning, Nadia.
Today's Appointments
0
Total Patients
0
in your system
Unread Messages
0
0 awaiting reply
Monthly Revenue
$0
paid this month
Revenue This Week
Today's Timeline
Today's Schedule
Appointments
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Patients
Before & After
Photo documentation with provider notes
Maria G.
LipoAway · Abdomen ·
Before
Place
photo
here
After
Photo
saved
Note: Excellent results — 3.5in waist reduction in one session
Jessica T.
Dermal Fillers · Lips ·
Before
Place
photo
here
After
Place
photo
here
Note: 1ml Juvederm Ultra, natural lip enhancement
Amanda K.
RF Microneedling · Full Face ·
Before
Place
photo
here
After
Photo
saved
Note: Significant texture improvement, visible pore reduction
Rachel M.
Botox · Forehead + Crow's feet ·
Before
Place
photo
here
After
Photo
saved
Note: 50 units total · 2-week follow-up booked
Messages
SMS · Email · All in one inbox
Inbox
Automated Messages
Inbox 5
Amanda K.9:41am
Quick question about my appt...
SMS
Nicole B.8:15am
Can I reschedule to 2pm?
SMS
Sarah P.Yesterday
Thank you so much Nadia!
Email
Carmen L.Yesterday
What's the recovery time for...
Email
Maria G.Mon
Your appointment is confirmed...
SMS · Auto-sent
Amanda K.(623) 555-0391 · SMS
Hi Amanda! Your RF Microneedling is confirmed for tomorrow at 11:15am with Remy. Reply STOP to opt out.
Yesterday · 4:02pm · Auto-reminder
Hey! Quick question — do I need to do anything to prep my skin before coming in?
Amanda K. · 9:41am
Suggested replies
Avoid retinol 24hrs prior
Come with clean, dry skin
Send prep guide PDF
Payments
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Today's Revenue
$0
This Month
$0
all transactions
Pending
$0
unpaid invoices
Transactions
0
this month
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Transaction History
Quick Charge
Patient
Service
Amount
$150
$150
$350
$720
$1,200
$2,400
$4,800
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Before Photo
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Review
Before & After
Before
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After
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Same guide outline ensures match