Free Consultation

This consultation form is intended as a quick, convenient way to collect the information we need to confirm that you can achieve the results you want with our treatments. It is important that you answer the questions accurately so that treatment parameters can be constructed specific to your skin and hair type.
* Name (first/last):
* Email Address:
Phone Number:
For a more detailed evaluation, please complete the entire consultation form.
Address Line 1:
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
City:
State:
Zip Code:
Is your skin suntanned? (Check if yes.)
Color of hair to be removed:
Black
Light-blond
Brown
Red
Reddish-brown
White
Light-brown
Grey
Gender: Female Male
Areas to treat (check all that apply):
Upper Lip Arms
Abdomen
Chin Shoulders
Pubic Area
Face Upper Back
Buttocks
Neck
Lower Back
Upper Leg
Under Arms Chest
Lower Leg
Full Body Skin Tightening
Veins Treatment
Skin type: Type I: Always burns in the sun. Never gets tan. Fair skin, light         eyes.
Type II: Sometimes burns, but it turns to tan. Fair skin, medium to        dark eyes, light brown- brown hair.
Type III: Usually tans, can burn as well. Medium skin; medium to         dark eyes, brown hair.
Type IV: Seldom burns. Dark brown skin, dark eyes, brown black         hair.
Type V: Almost never burns. Get dark in the sun. Dark skin, hair         and eyes.
Type VI: Very dark. Never burns. Possibly African-American or         West Indian descent.
Are you taking, or have you taken Accutane in the last six months? Yes No
Are you taking any medication that causes photosensitivity?
Yes No Not sure
If you are not sure, which medicines are you taking?
Additional Comments:
Please include the color of the hair to be treated, your skin type, the areas to be treated and any other information you think is important.

There are other questions that will be asked when you come in for your consultation, but these give us some of the basic information that we need.

* These fields are required