Advanced Laser Clinics of Illinois

Leading Professionals in Personal Image Enhancement

Advanced Consultation Form (still free!)

So, you want to get a more detailed picture of what your options are.

You've come to the right place in reaching our Advanced Consultation Form. This information will allow us to much better assess what treatment paths are available to you.

That being said, if you look over the questions below and feel that you'd rather discuss things with a living, breathing human... either give us a call, or please follow this link back to our Basic Consultation Form Where you can arrange to have someone get back to you quick, fast and in a hurry.

1. What body area are you considering for laser hair removal?

2. What have you previously used to remove your unwanted hair?
Please check all that apply...

Nothing
Waxing
Tweezing
Shaving
Nair, Epilstop
Bleaching

3. What color is your hair in the area you are thinking about treating?

Black
Brown
Blonde
Gray
White
Light Brown
Light Blonde
Red

4. What color is your skin in the area you are thinking about treating?

White
Brown
Black
Light Brown

5. Do you have a sun tan?

Tan
Slight Tan
No Tan

6. What is your skin type in the area you are considering for laser hair removal?

Type 1 - Always burn, never tan (extremely fair skin, blonde hair, blue/green eyes)
Type 2 - Usually burn, tan less than average (fair skin, sandy brown to brown hair, green/blue eyes)
Type 3 - Sometimes mild burn, tan about average (medium skin, brown hair, green/brown eyes)
Type 4 - Rarely burn, tan more than average (olive skin, brown/black hair, dark brown eyes)
Type 5 - Moderately pigmented, you tan deeply (dark brown skin, black hair, black eyes)
Type 6 - Deeply pigmented, you never burn (black skin, black hair, black eyes)

7. Have you been on Accutane in the past 6 months?

Yes
No

8. Are you currently on any medication(s)?

Yes
No

If yes, does it cause photosensitivity?

Yes
No
Not Sure

What is the name of the medication?

Any other questions you would like answered?

9. Contact information. All information is confidential and never shared.

Name:

Address:

City:

State:

Zip:

Daytime Phone Number:

Email Address:

How would you like us to contact you?
Telephone
Email

Would you like a free brochure mailed to your home?
Yes
No

Thanks for making contact, we look forward to talking with you.