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Step Form
Select Gender
Select Gender
Male
Female
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How Old Are You
Age
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Choose Your Skin Concern
Female
Acne & Pimples
Pigmentation & Dark Spots
Uneven Skin Tone
Dark Circles
Wrinkles & Fine Lines
Dull Skin / Glow Issues
Male
Acne & Oily Skin
Dark Spots & Acne Scars
Hair Loss / Balding
Pigmentation
Razor Bumps
Large Pores & Excess Oil
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Is this your first time getting a skin treatment?
Pervious Skin Treatment
Yes
No
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If yes:
When was your procedure done?
Date / Time
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What is your preferred time for starting treatment?
Star Time
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Are You Taking Any Medications or Do You Have Any Disease?
Leave blank if none apply
Medical Conditions
Current Medications
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