Pittsford Laser Spa, Inc.
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Our Address

Pittsford Laser Spa, Inc.
3300 Monroe Ave, Suite #203
Pittsford, New York 14618
Phone: 585-248-5274

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Pittsford Laser Spa, Inc. Consultation

Get started today with the Laser Hair Removal process...
you can be hair free sooner than you think!

Complete the following questionnaire to find out if you are a candidate for Laser Hair Removal.

ALL INFORMATION IS STRICTLY CONFIDENTIAL.
We Never Sell Your Name or Email Address. We Value Your Trust In Us. Thank You!

Please fill in all the information below. Required fields are marked with an *.
* 1. What body area are you considering for laser hair removal?
* 2. What have you previously used to remove your unwanted hair?
Please select all that apply.
Nothing
Waxing
Tweezing
Shaving
Nair, Epilstop
Bleaching
* 3. What color is your hair in the area you want to be treated?
* 4. What color is your skin in the area you want to be treated?
* 5. Do you have a sun tan?
* 6. What is your skin type in the area you are considering to have laser hair removal?

Type I- Always burn, never tan (extremely fair skin/blond hair/blue/green eyes)
Type II- Usually burn, tan less than about average (fair skin, sandy brown to brown hair, green/blue eyes)
Type III- Sometimes mild burn, tan about average (medium skin, brown hair, green/brown eyes)
Type IV- Rarely burn, tan more than average (olive skin, brown/black hair, dark brown/black eyes)
Type V- Moderately pigmented, tans profusely (dark brown skin, black hair, black eyes)
Type VI-Deeply pigmented, never burns (black skin, black hair, black eyes)
* 7. Have you been on Accutane in the past 6 months? Yes No
* 8. Are you currently on any medication? Yes No
If yes, does it cause photosensitivity? Yes No Not Sure
What is the name of the medication?
Any other questions you would like answered:
* 9.) Personal information. Please fill in the appropriate information for better service.
All Information is Strictly Confidential!
* Name
*Address
* City
* State
* Province / Region (Outside U.S. Only)
* Zip Code/ Postal Code
* Country 
* Phone Number
* 10. What e-mail address would you like the analysis results sent to? E-mail must be provided to receive information!


Required fields are marked with an *.  Make sure that all the required fields are filled out.
Thank you.
We will respond to your request via e-mail.

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