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Contact Us

Step 1 of 5

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CLIENT INFORMATION & MEDICAL HISTORY

In order to provide you with the most appropriate laser treatment, we need you to complete the following questionnaire. All information is strictly confidential

PERSONAL HISTORY

Client Name(Required)
DD slash MM slash YYYY
Date of Birth(Required)
Which of the following best describes your skin type?(Required)

MEDICAL HISTORY

Are you currently under the care of a physician?(Required)
Are you currently under the care of a dermatologist?(Required)
Do you have a history of erythema abigne, which is a persistent skin rash produced by prolonged or repeated exposure to moderately intense heat or infrared irritation?(Required)
Do you have any of the following medical conditions? (Please check all that apply)(Required)
Have you ever had an allergic reaction to any of the following? (Please check all that apply and describe the reaction you experienced)(Required)

MEDICATIONS

What oral medications are you presently taking?(Required)

Have you ever used Accutane?(Required)
What topical medications or creams are you currently using?[(Required)

HISTORY

Have you ever had laser hair removal?
Have you used any of the following hair removal methods in the past six weeks?(Required)
Have you had any recent tanning or sun exposure that changed the color of your skin?(Required)
Have you recently used any self-tanning lotions or treatments?(Required)
Do you form thick or raised scars from cuts or burns?(Required)
Do you have Hyperpigmentation (darkening of the skin) or Hypopigmentation (lightening of the skin) or marks after physical trauma?(Required)

For Our Female Clients:

Are you pregnant or trying to become pregnant?(Required)
Are you breastfeeding?(Required)
Are you using contraception?(Required)
Consent(Required)
DD slash MM slash YYYY
Maroc Hammam Spa is the women’s only ultimate urban sanctuary for those seeking solace from the day-to-day hustle.
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  • 2552 Stonebrook Pkwy suite # 730, Frisco.Texas 75034
  • [email protected]
  • (469) 803 5833
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