PRE-CONSULTATION QUESTIONNAIRE
Please answer a few quick questions so we can give you the best advice!

STEP ONE

COMPLETE APPLICATION

STEP TWO

TREATMENT ASSESSMENT
Skin Type - If exposed to the sun WITHOUT sun protection for over 1 hour would you? Select Options Below
Always burn, NEVER tan
Always burn, SOMETIMES tan
Sometimes burn, SOMETIMES tan
Always Tan
Hispanic, Asian, Mediterranean, Middle Eastern
Black
When Were You Last Exposed*
Are You Going On Holiday To The Sun*
Do You Use Chemical Tanning or Sunbeds?*
What Areas Are You Looking To Have Treated*
How Often Would You Shave The Area*
Have You Had Any Prior Laser Hair Removal Treatment With Us Or Any Other Clinic *
Job Description*
Medical Info*
Medical Conditions*
Skin Conditions*
Unit 1, Mayor Street Lower, Dublin 1
13 Main Street, Dundrum, Dublin 14
www.havanaskinclinic.com
01 424 2010
book@havanaskinclinic.com
Copyright © 2019 - Havana Skin Clinic