Electrolysis Consultation Request

Electrolysis Consultation Request

Permanent Hair Removal Clinic
WELCOME

Thank you for choosing Star Wellness. We are not able to take new clients until late July. Please complete the following intake form and we will be in touch via automated text with a date/time that fits your availability. I look forward to meeting you.

CURRENT WAIT TIME

Up to 6 weeks. Cancellation List Available.

HOURS

Mondays 1:00pm - 9:00pm
Tuesdays 1:00pm - 9:00pm
Thursdays 1:00pm - 9:00pm
Fridays 1:00pm - 7:00pm
Name*

First NameLast Name
Cell Phone Number*
For Reminder Texts. Please double check number.
Email (please double check spelling)*
example@example.com
Address (All information will be kept confidential)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is your preferred appointment time?*

AnytimeAfternoonEveningsI work shift work so it dependsOther
What is your preferred appointment day?

Any DayMondaysTuesdaysThursdaysFridays
What area's are you considering for Electrolysis?*
What temporary methods have you used on these areas?*

ShavingPluckingWaxingSugaringDepilatory CreamBleachingLaserN/A
How often are you using these temporary methods?*

Every dayEvery Second DayOnce a WeekAs NeededOther
Please list any medical conditions
Please list any medications or prescription creams
Additional Comments or Questions
24 HOUR CANCELLATION POLICY

The full appointment fee will be due for all appointments cancelled, rescheduled or missed within 24 hours of the appointment date/time. If you have a package, the time will automatically be deducted from your package. If you do not have a package, E-transfer can be sent upon notice and must be paid before your next appointment is scheduled. I am understanding of weather and emergencies while being mindful of those who may take advantage of my kindness. Thank you for understanding.
Please cancel your appointment if you are sick. If you are truly sick there will be no cancellation fee. I do keep notes and repeat offenders will need to pre-pay. Thank you for your cooperation.*

I understand and will cancel my appointment if I am sick or showing symptoms of runny nose, cough or fever.
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