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.Format: (000) 000-0000.
Age range:
Areas of interest (check all that apply):
How would you describe your natural skin tone (Fitzpatrick skin type)?
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?
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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