Laser Models Needed
Get 40% OFF All Laser Services! Fill out the Form Below. You can choose more than 1 area. or type of service. Laser Services will be performed at Wellness Spa Rx Reunion Location: 18335 E 103rd Ave suite 203 Commerce City, CO 80022. Once you fill out this form you will be in our Model Data Base.
Patient Data
Patient Name
First Name
Last Name
Age
Gender
Please Select
Male
Female
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Have You Ever Been A Model for us Before?
Yes
NO
Which Service are you interested in?
Carbon Laser Facial
Toe Fungus Removal
Tattoo Removal (only small area 1"x1" or fine line, black ink only)
Laser hair Removal
If Laser Hair Removal, Which area are you interested in. Can choose multiple areas.
Lip
Cheeks
Sideburns
Full Face
Underarms
Fingers
Toes
Beard/neck
Buttocks
Full Head
Bikini
Back
Chest
Half Arms
Full Arms
Brazilian
Half Legs
Full Legs
Full Body
Have you had this service done in the past?
Yes
No
Are you currently taking any medications? If yes, please list them below:
Did you undergo any surgery in the past? If yes, please indicate when, the name and or location of the surgery:
Which time of day works best for you?
Daytime 9-3pm
Evening 4-7pm
Weekends
Print Form
Submit
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