Consultation Form

Meet Anita for a FREE 20 minutes complimentary consultation who will create a personalized
Electrolysis Permanent Hair Removal plan just for YOU!

Name*
Date of Birth*
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Areas To Be Treated

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Hormone-Related Questions

Regular menstrual cycle?
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Previous Methods of Hair Removal

Select ALL methods that you have used, write which areas of the body, add date when last used and how many years total*
How often do you remove your hair? (select all that apply)*
Skin reactions to previous hair removal methods (select all that apply)*
Permission to photograph area to be treated (used exclusively for RenieBeautyElectrolysis.com site before and after photos)*

Acknowledgment of Information

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Name*
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How would you like Renie Beauty Electrolysis to contact you for appointment reminders, special offers, etc?*

Areas To Be Treated

Select all areas to be treated*