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American Laser Centers - Rockville Center, NY
Rockville Centre, NY

Clinic Details:
American Laser Centers - Rockville Center, NY
Specialty:Laser Hair Removal
Contact: SignatureSpecialists Certified
Phone: (866) 839-4465
Address: 371 Merrick Rd, Suite #405
Rockville Centre, NY 11570
Office Hours: Mon., to
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Contact American Laser Centers - Rockville Center, NY:
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Title:
Name (first/last):
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For a more detailed evaluation and to save 10% off your first treatment (at participating clinics) complete the entire consultation form.
Street Address:
Apt #:
City:
State:
Zip Code:
Is your skin suntanned? (Check if yes.)
Color of hair to be removed:
Black
Brown
Reddish-brown
Light-brown		Light-blond
Red
White
Gray
Gender:
FemaleMale
Areas to treat (check all that apply):
Upper Lip
Chin
Face
Neck
Under Arms		Arms
Shoulders
Upper Back
Lower Back
Chest		Abdomen
Pubic Area
Buttocks
Upper Leg
Lower Leg
Skin type: Type I: Always burns in the sun. Never gets tan. Fair skin, light eyes.
Type II: Sometimes burns, but it turns to tan. Fair skin, medium to dark eyes, light brown- brown hair.
Type III: Usually tans, can burn as well. Medium skin; medium to dark eyes, brown hair.
Type IV: Seldom burns. Possibly Mediterranean, Asian or Hispanic descent. Olive skin, dark eyes, brown black hair.
Type V: Almost never burns. Get dark in the sun. Possibly Mediterranean, Asian, Hispanic or other descent. Dark skin, hair and eyes.
Type VI: Very dark. Never burns. Possibly African-American, Indian or West Indian descent.
Are you taking, or have you taken Accutane in the last six months?
 
YesNo
Are you taking any medication that causes photosensitivity?
 
YesNoNot sure
If you are not sure, which medicines are you taking?
Additional Comments:

Please include the color of the hair to be treated, your skin type (click here for skin type chart), the areas to be treated and any other information you think is important.

There are other questions that will be asked when you come in for your consultation, but these give us some of the basic information that we need.
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