Contact Us

Online Consultation

See if you are a candidate for Laser Hair Removal. Feel free to call us with any questions that you may have. All of your information will be handled with the utmost confidentiality.

1. Personal information. Please fill in the appropriate information for better service.
Gender	Female Male
Name
Address
City
State
Zip / Postal Code
Country
2. Contact Information
Phone Number
Would you like us to call you? (strictly confidential)	Yes No
Would you like a free brochure mailed to you?	Yes No
What e-mail address would you like the analysis results sent to? E-mail must be provided to receive information!
3. What body area are you considering for laser hair removal?

4. What have you previously used to remove your unwanted hair?
Please check all that apply: Nothing Waxing Tweezing Shaving Nair, Epilstop Bleaching
5. What color is your hair in the area you want to be treated?
Black Brown Blonde Grey White Light Brown Light Blonde Red
6. What color is your skin in the area you want to be treated?
White Brown Black Light Brown
7. What is your skin type in the area you are considering to have laser hair removal?
Type I- Always burn, never tan (extremely fair skin/blond hair/blue/green eyes)
Type II- Usually burn, tan less than about average (fair skin, sandy brown to brown hair, green/blue eyes)
Type III- Sometimes mild burn, tan about average (medium skin, brown hair, green/brown eyes)
Type IV- Rarely burn, tan more than average (olive skin, brown/black hair, dark brown/black eyes)
Type V- Moderately pigmented, tans profusely (dark brown skin, black hair, black eyes)
Type VI-Deeply pigmented, never burns (black skin, black hair, black eyes)
8. Medical History
Have you been on Accutane in the past 6 months?	Yes No
Are you currently on any medication?	Yes No
If yes, is it photosensitive?	Yes No Not Sure
What is the name of the medication?

The Woodlands
9191 Pinecroft - Suite #100
The Woodlands, Texas 77380
281.419.0080

Memorial Area
1415 S Voss - Suite #230
Houston, Texas 77057
713.953.1139

River Oaks
1701 South Shepherd Dr. - Suite C
Houston, TX 77019
713.523.1701