Why Get Lazed?
Laser Hair Removal
What To Expect
Make an Appointment
Get Lazed & Rejuvination Institute
Get Lazed & Rejuvenation Institute
Before Filling Out the Form- Take This Skin Test Questionnaire to See if You Are an Ideal Candidate!
Areas to be treated
Past or present Illness/ Medical Conditions/ Allergies, please list
Accutane, Antibiotics, Aspirin, Iron supplements, Gold therapy, Cournadin, drugs which may cause photosensitivity this includes herbal supplements
Please list dosage of oral antibiotics/Accutane and date of last dose taken:
Please list any topical medications you are using:
Do you have a history of any autoimmune disease?
Do you have a history of HSV1 or HSV2?
Do you have any implants/ injectables/ permanent make-up? Ifso, please list:
Do you have any tattoos? Please list locations:
Are you pregnant?
Do you have a history of keloids/hypertrophic scars?
Tanning History (including direct sun, self tanners, spray tans) Please list and last date of use:
Previous Laser Treatment: (specify date/ number of treatments/ frequency/ tissue response/ device used)
Previous Hair Removal History
select all that apply
Frequency/ last use of above modalities:
Other type treatment
Have you ever had a cosmetic peel/procedure? Please list
I agree that the information listed above has been reviewed and presented with my clear understanding of what this procedure involves. All of my questions have been addressed to my satisfaction
Fitzpatrick Skin Quiz Score (Link at top of the page)
Score: 0-7 Skin Type: I
Score: 7-13 Skin Type: II
Score: 14-20 Skin Type: III
Score: 21-27 Skin Type: IV
Score: 28-34 Skin Type: V
Score: 35+ Skin Type: VI
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525 Route 70 Suite 2B,