Online Laser Hair Removal Consultation

What body area are you considering for laser hair removal?
Under Arms   Bikini   Brazilian   Back   Legs Face  
Head    Arms   Neck   Shoulders   Abdomen   Upper Chest   
Feet   Aureole's Hands   Buttocks   Anal    Other
What have you previously used to remove your unwanted hair? Please select all that apply.
Bleaching   Depilatory/Nair   Shaving   Electrolysis  
Tweezing   Waxing   Nothing  
What color is your hair in the area you want to be treated?
What is your ethnicty?
Do you have a sun tan?
What is your skin type:
Have you been on Accutane in the past year?
Yes No
Are you currently on any medications or antibiotics?
Contact Information
Name:

Phone Number:

Email:

How would you like us to contact you:
 Phone    Email    Mail
Address:

City:

State:

Zip Code:

 
This is an information-only request to help us determine what services are appropriate. Clients will still have a free, in-person consultation with one of our experienced staff prior to initiating any treatments