Photo Rejuvenation Online Consultation
Our Free Online Consultation is a quick and confidential way to find out if you are a good candidate for Photo Rejuvenation treatments.
| 1. What area are you considering for Photo Rejuvenation treatment? | ||||
| 2. Do you have any medical conditions? | ||||
| 3. Are you currently taking any medications? | ||||
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Yes
No What is the name of the medication? (Please list any an all medications, including natural products such as St-John's Wort) |
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| 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 for photorejuvenation? | ||||
| 7. Have you been on Accutane in the past 6 months? | ||||
| Yes No | ||||
| 8. What is your sex? | ||||
| M F | ||||
| 9. Personal information. (All Information is Strictly Confidential!) | ||||
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| We will respond to your request via e-mail |
