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Carbon Laser Facial Waitlist
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1
What areas are you interested in treating?
Face
Neck
Decolletage (upper chest)
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2
How would you describe your skin?
Oily
Dry
Sensitive
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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
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4
How did you hear about UNBRANDED Austin
I'm a Current Client
Google
FB/Instagram
Reddit
Referral
Ad/ Flyer
Other
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5
What kind of referral?
Military/ Police Recruiter
Tattoo Artist
Spa
Other Client
Other
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6
Do you have a Promo code?
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7
Do you have any known allergies, especially to carbon, bee products, or other skincare products?
SKIP, if no
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8
Are you currently taking any medication, supplements, or herbal remedies?
SKIP, if no
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9
Please indicate if you've had any reactions to laser treatments in the past?
SKIP, if no
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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
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11
What are your primary skin concerns for this treatment?
Acne
Acne Scarring
Sunspots/ Age Spots
Melasma/ Hyperpigmentation
Uneven Skin Tone
Fine Lines
Enlarged Pores
Dullness
Dark Circles under Eyes
Keratosis
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12
Have you used any retinol or other strong skincare products recently?
YES
NO
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13
In the past 6 months, have you had any other facial treatments, peels, or laser procedures?
SKIP, if no
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14
Do you smoke, and are you willing to avoid smoking before and after the treatment?
SKIP, if not applicable
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15
How often are you exposed to the sun, and are you willing to use sun protection as advised?
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16
Please provide any other information you'd like for us to know.
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17
Please enter your name.
*
This field is required.
First Name
Last Name
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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
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19
Please enter your Email.
*
This field is required.
We never send any spam messages or share with any other party.
example@example.com
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20
Please verify that you are human.
*
This field is required.
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21
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