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Laser Hair Removal Online Consultation

Our Free Online Consultation is a quick and confidential way to find out if you are a good candidate for laser hair removal services.

1. What body area are you considering for laser hair removal?
2. What have you previously used to remove your unwanted hair? Please select all that apply.
Nothing
Waxing
   Tweezing
Shaving		   Nair, Epilstop
Bleaching
3. What color is your hair in the area you want to be treated?
4. What color is your skin in the area you want to be treated?
5. Do you have a sun tan?
6. What is your skin type in the area you are considering to have laser hair removal?
7. Have you been on Accutane in the past 6 months?
Yes No
8. Are you currently on any medication?
Yes No

If yes, is it photosensitive?

Yes No Not Sure

What is the name of the medication?
(Please list any an all medications, including natural products such as St-John's Wort)
9. Personal information. (All Information is Strictly Confidential!)

Name
*
Phone Number
*
E-mail address
*

Would you like us to call you?
Yes No

Would you like a free brochure?
Yes No

Address

City

Province / State

Zip Code/ Postal Code

Country
We will respond to your request via e-mail

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