Thank You for your Interest in LaserHere.com
 
Thank you for your interest in the Services of LaserHere.com.  We are happy to share our pricing with you at this point.  We will however ask in return just a little information about yourself to verifiy that you are indeed an interested customer, not just an interested competitor.  Please fill in the following brief form and survey.  Once we verify your contact details we will send you out an email and links to private parts of our website where you can get the answers to all your questions and all our great pricing and offers.

We will also be subscribing you to our famous Newsletter series that will educate and inform you about Laser Hair removal and offer you lucrative discount offers from time to time.  Of course you can remove yourself from this series at anytime.

Once again, we thank you for your interest and look forward to seeing you soon.
Date: 8/28/2008
 
Firstname:
Lastname:
Phone Number:
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City
Province/State: Other:
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Quick Questionnaire:

1.  Have you ever had Laser Hair Removal Done before?
Yes
No
2.  Please share with us your skin type

3.  Please share with us your Gender?

4.  Which part of your body would you like to treat?
Forehead
Sideburns
Cheek
Upper Lip
Chin
Nose
Full Face (Cheek, Upperlip, Chin, Sideburns)
Neck
Back of Neck
Back of Shoulders
Shoulders
Chest
Under Arms
Breasts
Cleavage
Abdomen
Lower Arms
Upper Arms
Full Arms (Lower and Upper Arms, Shoulders)
Hands
Fingers
Back
Extended Back
Linea (around the belly button)
Gluteus Maximus (bum)
Inner Gluteals
Knee
Lower Leg
Feet
Toes
Thigh
Full Legs (thigh, Knee, Lower leg)
Bikini Line
Brazilian Bikini (Bikini+top of Bikini)
5.  How much would you expect to spend for Laser Hair Removal?

6.  How did you learn about us?

7.  If you learned about us from your friend or our staff please let us know their Name and/or ID number

8.  Have you been to AOI Beauty Studio?
Yes
No
9.  If you answer yes to Question 6 please give us your ID number

10.  Are you interested in IPL treatments? (Intense Pulsed Light like Photo Facial,Skin Rejuvenation)
Yes
No
11.  Please check the IPL (intense pulsed light) treatments you may be interested in. (ie. Photo Facial)
Sun Spot Removal by IPL Photo Facial (Intense Pulsed Light)
Age Spot Removal by IPL
Wrinkle Reduction by IPL
Acne, Acne Scar Reduction by IPL
Pore Size Reduction by IPL
Cellulite Reduction
Facial Massage
Chemical Peel
Botox
Face Lift (Surgical)
Laser Tooth Whitening
No Thanks
Other
12.  If you have any other treatments you are interested in, please let us know.

13.  If you have any question about our services please let us know.