Appointment Request Form Name * First Name Last Name Phone * (###) ### #### Email * What areas would you like treated? * Chin Jaw line Lip area Brows Side burns Nose (not inside) Ears (not inside) Back Shoulders Chest/Breast Stomach Underarms Legs Arms Fingers Toes Buttocks (cheeks) Bikini Line (Excludes genitalia) Not sure yet Have you had electrolysis treatments before? Yes No I understand several sessions are necessary to achieve permanent results. Average length of treatment varies widely based on individual factors. * I understand I understand that Like Velvet Electrolysis does not participate in any medical expense reimbursements for electrolysis treatments nor associated or contracted with any Health Insurance Organization. * I understand I agree to abide by all of Like Velvet Electroysis's policies. * I understand Terms & Conditions - I understand a series of treatments over 12-24 months, possibly longer, may be necessary to achieve permanent hair removal based on the science of Electrology and individual factors. I acknowledge there are possible risks related to treatment. I agree to follow all post electrolysis instructions. Like Velvet Electrolysis has the right to refuse service to anyone at any time. * I have read, understand, and agree to the Terms & Conditions above. Thank you!
