Precise Laser Hair Removal & Esthetics

Client Intake & Consent — this only needs to be filled out once.

Step 1 of 5 — Contact Info

First Name

Last Name

Birthday

Address

City

State

Zip

Phone Email Emergency Contact Name & Number How did you hear about us?

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? 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

When was your last treatment?

Skin Type (provider will confirm)

Tap each statement to initial it. Your initials (--) come from your name on step 1.

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

We run specials throughout the year, including birthday offers, promotions, gift certificates, and discounts. Optional — you can opt out any time.

Yes — send me birthday specials, promotions, gift certificates, and discounts by text and email.

I have received and reviewed the Aftercare Instructions and agree to follow them after each treatment.

Client is under 18 (a parent/guardian signature is required).

Type your name below as your signature.

Client Signature (type full name)