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Treatment / Service you are considering

Is your skin tanned?

Color of Hair

Areas to treat (check all that apply)

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?

Are you taking any medication that causes photosensitivity?

How did you hear about us?

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