New patients | Lux Ukiah

NEW TO LUX? PLEASE COMPLETE THE FORM BELOW

This form is for new patients to submit their information to become a patient at Lux. This form helps me understand who you are and what you're looking for before we meet.

I read every submission personally. There are no right or wrong answers. Your honest responses help me figure out if we're a good fit for each other.

Sorry, but you have reached the submissions limit and this form is now closed.

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. If it sounds like a good fit, I'll reach out by text with a link to schedule your first appointment. If I don't think I'm the right provider for what you're looking for, I'll say so honestly.

— Rachel