What body area are you considering for laser hair removal? *

What have you previously used to remove your unwanted hair? *
Please select all that apply.

Nothing
Bleaching
Electrolisis
Shaving
Threading
Tweezing
Waxing

What colour is your hair in the area you want treated? *

Black
Brown
Light Brown
Grey
White
Blonde
Light Blonde
Red
Other

What colour is your skin in the area you want treated? *

Black
Brown
Light Brown
White

Do you have a suntan? *

No Tan
Slight Tan
Tan

What is your skin type in the area you want to have laser hair removal? *

Type I - Always burn, never tan.
Extremely fair skin/blonde 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 V - Moderately pigmented, tans profusely.
Dark brown skin, black hair, black eyes

Type VI - Deeply pigmented, never burns.
Black skin, black hair, black eyes

Yes No

If yes, is it photosensitive?

Yes No Unsure

Name(s) of any medication:

Yes No

Yes No

Full Name *

Address Line 1

Address Line 2

Address Line 3

City

Post Code

Telephone Number

Email Address *

Please Confirm Email Address *