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ALL
INFORMATION WITH * IS REQUIRED |
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* Name: |
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* Phone Number: |
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* Email Address: |
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Newsletter acceptance: |
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1. What body area are
you considering for laser hair removal? |
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2. What have you
previously used to remove your unwanted hair?
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3. What color is your
hair in the area you want to be treated? |
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4. What color is your
skin in the area you want to be treated? |
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5. What is you skin
type in the area you are considering to have laser
hair removal? |
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Type I- Always burn, never tan
(extremely fair skin/blond hair/blue/green eyes) |
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Type
II- Usually burn, tan less than about average
(fair skin, sandy brown to brown hair,
green/blue eyes)
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Type
III- Sometimes mild burn, tan about average
(medium skin, brown hair, green/brown eyes) |
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Type
IV- Rarely burn, tan more than average (olive
skin, brown/black hair, dark brown/black eyes) |
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Type
V- Moderately pigmented, tans profusely (dark
brown skin, black hair, black eyes) |
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Type
VI-Deeply pigmented, never burns (black skin,
black hair, black eyes) |
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7. Additional Information that you
would like to share, or questions that you may have? |
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8. Do you have a sun tan?
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All information on this application
is kept confidential and will be disclosed without
the written consent of Affordableskincareny.com and
by the patient. By clicking on the Submit below you
are only requesting more information about about
Hair Removal procedure. |
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