IPL/Clearlift Laser - Model Application Form

IPL/Clearlift Laser - Model Application
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Age range:*

18–2425–3435–4445–5455–6465+
Areas of interest (check all that apply):*

FaceNeckChest
How would you describe your natural skin tone (Fitzpatrick skin type)?*

Type I – Very fair, always burns, never tansType II – Fair, usually burns, tans minimallyType III – Light–medium, sometimes burns, gradually tansType IV – Medium, rarely burns, tans easilyType V – Medium–dark, very rarely burns, tans very easilyType VI – Deeply pigmented, never burns
Current skincare routine (retinoids, Accutane, etc.)?*
Are you currently taking any medications or using topical products that may increase sensitivity to light or laser treatments?*

YesNoNot sure
If "yes" or "not sure" please list them below:
Recent sun exposure or tanning?*
Why are you interested in IPL, Clearlift or both?*
Please upload a photo of your face/neck/chest in natural lighting, standing in front of a window (not in a car + NOT with your back to the window - but with your eyeballs looking outside:) during the daytime.
File Upload*

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