Intake form

Help us serve you better

Name *

Email address *

What skin treatment are you interested in?

Please select at least one option.

Pigmentation and dark spot removal

Wrinkle reduction

Enlarged pores treatment

Laser hair removal

Skin rejuvenation

Anti-aging treatments

Acne treatments

What is your skin type?

Do you have any existing skin conditions?

Are you currently taking any medications related to skin treatment?

Have you had any previous skin treatments?

How did you hear about lumina laser beauty?

What is your preferred appointment date and time?

Do you have any allergies, particularly to skin products?

Additional questions or comments

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Lumina Laser Beauty