Laser Request Form

Laser Request Form

You will be contacted within 48 hours of your submission. All Advanced Esthetic Services will be performed at Elevated Image & Primary Care Clinic in Renton (T,Th, & limited Saturdays) at a discounted price, for training purposes.
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Are you over 18?*

YesNo
How did you hear about this opportunity?*
What advanced services are you most interested in? Check all that apply:*

Laser Hair RemovalLaser Tattoo RemovalRF MicroneedlingRF Microneedling w/PRPSpider Vein TherapyIPL Photorejuvenation
Model Pricing are as follows:

*Laser Hair Removal (every 6-8 weeks): $50 to $250 per session. Packages of 6 available.

*Tattoo Removal (every 4-6 weeks): $200/3in²palm size, per session or more specifically...

XS - smaller than a quarter : $50

S - up to the size of a credit card : $100-150

M - up to the size of a dollar bill : $150-250

L - up to the size of a greeting card : $250-350

XL - half sleeve & other : $350+

PMU Brow Unlimited Removal Package: $450

Bundle savings: 2 sessions for 10% off, 3 for 20% off, 4 for 30%, 5 for 40%, 6 for 50%. Unlimited Removal packages will be discussed with physician.

*RF Microneedling: $297.50

*RF Microneedling + PRP: $397.50 (blood draw performed by physician or nurse)

*Spider Vein Therapy per session: $125/0-15 min, $225/15-30 min, $300/30-45 min

*IPL (every 3 weeks until 3rd treatment): full face - $150, chest - $187.50, spot treat - $100
For pigmentation treatments (melasma/sunspots) or tattoo removal (including cosmetic) inquiries, please upload a photo of the pigmented area or tattoo to be removed

Cancelof
How old is the tattoo and have there been any previous treatments?
The treatments listed above are performed T,Th, and limited Saturdays at Elevated Image & Primary Care Clinic (Renton). Most of the treatments require topical anesthetics and will take 1.5-2 hours minimum. Select appointment date and time preferred. For a Saturday appointment, please text me directly at (206) 657-6222.
Optional- You may submit a booking deposit of $50 with this form. Payments can be submitted through:

Zelle: geekyesthetician@gmail.com (KGold)

cash app: kann1th

apple pay: 206-383-8586

*payment will go towards treatment cost.

You will be contacted with pre and post-care instructions for the requested service as well as any additional forms. The instructions MUST be followed for best results. Most care instructions will require the treatment area to be out of the sun and protected for a period of time, as well as the cease of Accutane for a minimum of 1 year. Must not be pregnant or breastfeeding, as these services may trigger stress responses in the body.

All services will be performed by Kannith M, LME with the guidance of a DO or RN.

Elevated Image & Primary Care Clinic (Dr. Joshua Hiep Le, DO) is located at:

4300 Talbot Rd S #105, Renton WA 98055
Should be Empty: