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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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*

Hormone-Related Questions

Regular menstrual cycle?
Select all that apply

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

(please initial each paragraph and sign at bottom of page)
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Name*
MM slash DD slash YYYY
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*