Laser hair removal survey

Fill This Survey for Best Results

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* 1. Have you had Laser hair removal before?

Yes

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* 2. If yes, On a scale of 1-10, how painful was the procedure? 0 is no pain at all, 10 is extremely painful

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 3. On a scale of 1 to 10, how would you rate the experience? 1 is extremely unsatisfied, 10 is extremely happy

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 4. Let us determine your skin Fitzpatrick score?

always burns, never tans (pale white; blond or red hair; blue eyes; freckles)

usually burns, tans minimally (white; fair; blond or red hair; blue, green, or hazel eyes)

sometimes mild burn, tans uniformly (cream white; fair with any hair or eye color)

burns minimally, always tans well (moderate brown)

very rarely burns, tans very easily (dark brown)

Never burns, never tans (deeply pigmented dark brown to darkest brown)

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* 5. How do you describe the unwanted hair that you would like to remove by Laser

Dark and fine

Dark and coarse

Light and fine

light and coarse

Other (please specify)

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* 6. Are you currently tan?

Yes

Never had it before

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* 7. What is the Area of the unwanted hair?

Extremities (arm or legs)

Trunk (abdomen or back)

Facial

Bikini or Brazilian

Full body

Other (please specify)

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* 8. Do you have any chronic skin condition such as Eczema?

Yes

Other (please specify)

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* 9. Do you take any medications such as antibiotics or water pills?

Yes

Other (please specify)

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* 10. What is the most important consideration when choosing a cosmetic clinic or spa

Reputation

The brand of the Laser machine

Prices and promotions

Location and parking

Social media profiles

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* 11. How did you hear about us?

Google search

Facebook ad

instagram ad

Printed media

word of mouth

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* 12. When are you planning to do the laser procedure

Less than two weeks

More than two weeks

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* 13. Please provide us with your information

First name

Last name

Email Address

Phone Number

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

Phone call

Text message