Hair Client Form - Canggu Bali | Cleanslate Laser Clinic

Step 1 of 4

25% Complete

Personal Information

First Name

Last Name *

Email Address *

Phone Number

50% Complete

Please write what areas you would like treated.

Step 3 of 4

75% Complete

Have you had laser before?

YesNo

Are you currently pregnant, breastfeeding or trying to conceive?

YesNo

Have you waxed or plucked or used hair removal sprays or creams in the areas to be treated within the last 28 days?

YesNo

Have you had laser before?

Step 4 of 4

99% Complete

Preferred Date *

Preferred Time *

Additional Notes