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COSMETIC INTEREST QUESTIONNAIRE
Issues of interest to you (please CIRCLE all that apply):
ISSUES OF INTEREST:
Botox for wrinkles
Botox for excessive sweating
Dermal Fillers for wrinkles
Chemical Peels
Skin Rejuvenation
Skin Care/Sunscreen Advice
Skin Care products
Microdermabrasion
Facials
Facial Veins
Laser Resurfacing (Pearl)
Leg Vein Treatments
Laser Hair Removal
Velashape
Sun Spots/Uneven Pigmentation
Waxing
Other, please specify: ______________________
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