Carbon Laser Facial Questionnaire

1

What areas are you interested in treating?

Face

Neck

Decolletage (upper chest)

2

How would you describe your skin?

Oily

Dry

Sensitive

3

How would you classify your skin type?This describes how your skin responds to the sun WITHOUT sunscreen

Type I - Always burns, never tans

Type II - Usually burns, sometimes tans

Type III - Sometimes burns mildly, gradually tans

Type IV - Rarely burns, easily tans

Type V - Very rarely burns, easily tans

Type VI - Never burns, very easily tans

6

Do you have a Promo code?

7

Do you have any known allergies, especially to carbon, bee products, or other skincare products?SKIP, if no

8

Are you currently taking any medication, supplements, or herbal remedies?SKIP, if no

9

Please indicate if you've had any reactions to laser treatments in the past?SKIP, if no

10

Do you have any underlying health conditions that might affect your skin or healing process, such as diabetes, autoimmune disorders, or skin conditions like eczema or rosacea?SKIP, if no

12

Have you used any retinol or other strong skincare products recently?

YESNO

13

In the past 6 months, have you had any other facial treatments, peels, or laser procedures?SKIP, if no

14

Do you smoke, and are you willing to avoid smoking before and after the treatment?SKIP, if not applicable

15

How often are you exposed to the sun, and are you willing to use sun protection as advised?

16

Please provide any other information you'd like for us to know.

17

Please enter your name.* This field is required.

First Name

Last Name

18

Please enter your phone number for this inquiry.This information will be kept private and we honor all requests to stop contact.

Phone number

19

Please enter your Email.* This field is required.We never send any spam messages or share with any other party.

example@example.com

20

Please verify that you are human.* This field is required.

21