Laser Hair Removal Follow-Up Questionnai | BEAUTY MD Women's SPA & Wellness Center

BEAUTYMD WOMEN'S SPA

& WELLNESS CENTER

Laser Hair Removal Follow-Up Questionnaire

First name

Last name

Date

Month

Day

Year

Treatment Area(s):

Since Your Last Laser Treatment

2. Have you used a tanning bed or self-tanner since your last treatment?

YES

NO

4. Have you started any new medications or supplements since your last visit?

YES

NO

Other

5. Are you currently taking antibiotics?

YES

NO

If YES, which?

6. Have you used Retinol, Retin-A, Tretinoin, Accutane, glycolic acids, salicylic acid, or other exfoliating products in the treatment area?

YES

NO

7. Did you apply any lotions, creams, oils, deodorant, perfume, or makeup to the treatment area today?

YES

NO

8. Have you exercised or used a hot tub, steam room, or sauna within the last 24 hours?

YES

NO

9. Have you exfoliated the treatment area within the last 48 hours?

YES

NO

10. When was the last time you shaved the treatment area?

Today

Yesterday

2 days ago

3+ days ago

11. Approximately how many times did you shave between your last laser session and today's appointment?

0

1-2

3-5

More than 5

14. Is there any chance you are pregnant or have you recently become pregnant?

YES

NO

N/A

15. Do you have any concerns or questions before today's treatment?

Client Acknowledgment

I confirm that the information above is accurate to the best of my knowledge. I understand that any changes in my medical history, medications, skin condition, or recent sun exposure may affect today's treatment or require it to be postponed for my safety.

Signature

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Date

Month

Day

Year