About Q Online Consult FAQ's Services Botox® / Juvederm™ Specials
If you never had a consultation with us, then you could fill out the Online Consultation form first, or alternatively, you could schedule an appointment online to request an in-person consultation.

All information provided will be kept confidential and will only be used for the purpose of laser skin therapy at Q Laser Center.
Phone: 524-1237
E-mail: appointments@qlaser.com
** Your E-mail:
** First Name
** Last Name
** Street Address
** City
** State
** Zipcode
** Phone
Please tell us how you heard about us
Radio
Television
Newspaper
Friend Referral
Telephone Book
Online Search
Other
I am interested in the following:
Hair Removal
Skin Rejuvenation
Spider Vein Therapy
Age/Sun Spot Therapy
Facials
Skinceutical Gel Peel
Cosmetic Make-up
Skincare
Other
Laser Hair Removal - Women
Facial
Underarms
Bikini Line
Arms
Legs
Other
If other please explain
Laser Hair Removal - Men
Facial
Chest/Abdomen
Back/Shoulders
Neck-Front
Neck-Back
Arms
Legs
Other
If other please explain
Hair color?
Current method(s) of hair removal?
Shaving
Tweezing
Waxing
Depilatories
None
What is your skin type?
Type I - always burns, never tans.
Type II - always burns, tans with difficulty.
Type III - burns mildly, tans slowly.
Type IV- rarely burns, tans with ease. Could be Asian or Hispanic descent.
Type V- almost never burn, gets dark.
Type VI- very dark
Do you have history of skin cancer?
Yes
No
Do you have history of diabetes?
Yes
No
Do you have history of keloids?
Yes
No
Please list medications ( last 6 months)
Medical History
Surgical History
Comments
Code Verification:

   
 
Prior to your scheduled appointment please remember the following:
Avoid sun/tanning 4-5 days prior
Shave area 24 hours prior
Remove all makeup, lotions, or creams from face
Arrive deodorant free if doing underarms
Arrive 10 minutes prior for paperwork
24 hour notice of cancellation or reschedule is appreciated.