Precise Laser Hair Removal

First Name

Last Name

Phone

Birthday

Email

Address

City

State

Zip

What areas are to be treated?

A few quick yes/no questions

Have you ever been on Accutane?

Hormonal problem you've been treated for?

Chemical peel or scars in treatment area?

Medications that make you sensitive to light?

Medications / herbal supplements / topical creams you use

Any allergies?

When was your last treatment?

How often do you remove your hair?

Daily

Twice Daily

Weekly

Other

Current hair removal methods (tap all that apply)

Waxing

Shaving

Sugaring

Creams

Tweezing

Electrolysis

The Fitzpatrick Scale

Not sure? Find the closest match above — your provider will confirm it at your visit.

Skin Type (provider will confirm)

Laser Hair Removal Consent

Photo Consent

I consent to clinical before/after photos being taken and stored in my file for treatment tracking.

How may Precise Laser contact you?

Text/email me about appointments, reminders, questions, and discounts.

Message and data rates may apply. You may withdraw text consent by replying STOP or contacting Precise Laser.

Sign & Submit

Type your name below as your signature.

Client Signature (type full name)

How did you hear about us?

Thank you!