Pure Aesthetics - Laser Hair Removal - Suitability Test

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

Are you currently on any medication? * Yes No

If yes, is it photosensitive? Yes No Unsure

Name(s) of any medication:

Are you aged 18yrs or over? * Yes No

Are you currently pregnant? * Yes No

Full Name *

Address Line 1

Address Line 2

Address Line 3

City

Post Code

Telephone Number

Email Address *

Please Confirm Email Address *