Have You Been With Us Before?
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Name (must match state issued ID)
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First Name
Last Name
If you prefer a different name please list name here
Phone Number
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Email Address
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Date of Birth (if you are under the age of 18, a parent or guardian must accompany you to your first appointment)
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MM
DD
YYYY
Sex (must match state issued ID)
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If you prefer to identify with a gender that does not match your ID, please select your preference
How did you hear about us (so we know who to thank)
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Friend/Family Member
Yelp
Google
Candela Website
Elta MD Website
Walk-In
SSLV Facebook
SSLV Instagram
SSLV Website
I am a...
Boyd Gaming Employee
M Life Employee
SLS Employee
Station Casino Employee
Wynn Employee
Other
If "Friend/Family Member" or "Other" please specify or list n/a if not applicable
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Pregnant/Nursing?
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Type(s) of Treatment (select all that apply)
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Desired Area(s) of Treatment
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Have You Tried This Before? If so, which parts of the body and at which salon?
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If Hair Removal, what color is the hair in the areas we are treating?
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Any waxing, threading/plucking, nair/veet in the areas we are treating in last 3 weeks - if yes, list which one and date(s)?
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Any sun exposure/tanning in the next/last 2 weeks in the areas we are treating - either sun, tanning bed, spray/bronzer - if yes, list which one and date(s)?
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Do you take any medications/supplements (prescriptions, over the counter vitamins, supplements, etc.)? If so, please list all
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Are you using any skin care products, creams, or serums in the areas you are wanting to treat? If so, please list all
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Desired Appointment Date (we will do our best to accommodate)
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MM
DD
YYYY
Time Slot
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Form Submitted By
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