New patients | Lux Ukiah

NEW TO LUX? PLEASE COMPLETE THE FORM BELOW

This form is the first step for new patients to book a consultation at Lux. As a boutique practice with limited space for new patients, I use this form to understand what you're looking for before we meet.

I read every submission personally. Your honest responses help me confirm if this type of clinic will be a good fit for your request. Thank you for taking the time to complete the form and I look forward to seeing you.

ABOUT YOU

First name

Last name

Email

Phone

Text is easiest for my small business.

Best way to reach you?

WHAT YOU'RE LOOKING FOR

Have you had aesthetic treatments before?

Yes, regularly - I have an established routine

Yes, a few times at different places

Once or twice

No, this would be my first time

What brings you to Lux specifically?

What did you read or hear that made you reach out?

What matters most to you in a provider?

Someone I can build a long-term relationship with

Honest guidance, even if it means no treatment

A provider who takes her time and doesn't rush

Deep expertise in a focused area

A calm, private environment

Select all that apply.

FIT AND AVAILABILITY

Most new patients wait four to six weeks for a first appointment. Does that work for you?

Are you looking for a long-term provider or exploring your options?

ANYTHING ELSE

Is there anything else you'd like me to know before we meet?

Previous reactions, concerns, questions, or anything at all. Optional.

Please note that pricing is discussed during your consultation. I'm not able to provide estimates in advance.

I read every form personally and respond within a few business days. I'll reach out by text with a link to schedule your consultation appointment. If I don't think I'm the right provider for what you're looking for, I'll say so honestly.

— Rachel