8345 Greensboro Dr, McLean (Tysons), VA 22102
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Gender *MaleFemaleOther
Treatment / Service you are considering *
Laser Hair RemovalCoolSculptingBody ContouringBotox & FillersVelashape III/ CelluliteIPL/ FotoFacialsLaser RejuvenationAnti AgingChemical PeelsSkin Tag & Cherry Angioma
Is your skin tanned? *YesNo
Color of Hair *BlackBrownReddish-BrownLight-BrownLight-BlondeRedWhite
Areas to treat (check all that apply) *
Upper LipChinFaceNeckUnder ArmsFull BodyArmsShouldersUpper BackLower BackChestSkin TighteningAbdomenPubic AreaButtocksUpper LegLower LegVeins Treatment
Skin Type *Type I: Always burns in the sun. Never gets tan. Fair skin, light eyes.Type II: Sometimes burns, but it turns to tan. Fair skin, medium to dark eyes, light brown- brown hair.Type III: Usually tans, can burn as well. Medium skin; medium to dark eyes, brown hair.Type IV: Seldom burns. Dark brown skin, dark eyes, brown-black hair.Type V: Almost never burns. Get dark in the sun. Dark skin, hair, and eyes.Type VI: Very dark. Never burns. Possibly African-American or West Indian descent
Are you taking, or have you taken Accutane in the last six months? *
YesNo
Are you taking any medication that causes photosensitivity? *
YesNoNot Sure
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