Did you know that not everyone is a candidate for laser hair removal?
Fill out this free confidential survey ( your information will not be released to a third party) to find out if you’re a candidate for laser hair removal.
Simply copy this form, paste it on to your e-mail service and e-mail this questionnaire to:
| Which of these methods did you use to get rid of your unwanted hair? |
Nothing
Waxing
Tweezing
Shaving
Electrolysis
Bleaching
YOUR ANSWER: _____________________________
| What color is your skin? |
White
Olive
Brown
Dark
Indian
Black
YOUR ANSWER: _______________________________
| What color is your hair? |
Dark
Blonde
Red
Grey
White
YOUR ANSWER: _______________________________
| Which area are you interested in having treated? |
YOUR ANSWER: ____________________________________________________________________
| Do you have a sun tan? |
YOUR ANSWER: ________________________________
| Are you currently on any medications? If yes, which medication/s? |
YOUR ANSWER: ____________________________________________________________________
| Would you like to receive free e-BOOKS on laser hair removal and skin care issues? If yes, please provide your e-mail address. We hate SPAM as much as you do, we will NOT share your e-mail address. |
YOUR E-MAIL ADDRESS:
| PERSONAL INFORMATION: WILL REMAIN CONFIDENTIAL |
Name: ______________________________
Address: ___________________________________
City: __________________________________
State: _________________________________
Zip Code: ______________________________
Phone Number: __________________________
| Would you like us to call you? We will not call you if you do not indicate that you want to receive a phone call. |
YES: _______
NO: _______
| What e-mail address do you want us to send your free analysis to? |
YOUR E-MAIL ADDRESS: ____________________________________________ Miami Laser Hair Removal 1037 Kane Concourse. Bay Harbour. Florida. 33154
305.864.3333
E-mail: miamilaserhairremoval@gmail.com
THIS SURVEY IS COPYRIGHTED AND DUPLICATION IS STRICTLY PROHIBITED.
