Laser Resurfacing Survey

Fill this Survey to get $100 discount on your Fraxel Laser session

Question Title

* 1. Have you had Laser skin resurfacing before?

Yes

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* 2. If yes, what was the procedure you had?

Fraxel Laser

Fractional Radio frequency Microneedling (Infini)

Chemical Peel

Carbon Peel

Other (please specify)

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* 3. What is the main skin issue you have now?

Acne Scars

Pigmentation

Skin texture

stretch marks

Other (please specify)

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* 4. Overall, how satisfied or dissatisfied were you with the results

Very satisfied

Satisfied

Neither satisfied nor dissatisfied

Dissatisfied

Very dissatisfied

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* 5. Do you use Sunblock on daily basis?

Yes

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* 6. Do you take a medication that makes your skin sensitive to sun light?

Yes

I am not sure

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* 7. Can you afford to stay at home for three days after the procedure?

Yes

I am not sure

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* 8. How did you hear about us?

Google search

Facebook ad

Instagram ad

Printed media

Word of mouth

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* 9. Please provide us with your information

First name

Last name

Email Address

Phone Number

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* 10. How do you like us to contact you?

Phone call

Text message