Appointment

APPOINTMENT FORM

*All fields must be filled in.

●Are you new to Skin Attraction?
New CustomerRepeat Customer

●Full Name

●Email Address

●Email Address (please type again)

●Cellphone Number

●Credit Card Infomation
Card Number：　
Expirelation(MM/YY)：　
Card Cord(CVS)：　

●Select a treatment menu.
---GEM IPL PRISM／GEM IPL プリズムClear & Brilliant／クリア＆ブリリアントThermage FLX／サーマクールPremium Rejuvenation Facial／プレミアム・アンチエイジング・フェイシャルSkin Ceuticals Medical Peeling／スキンシューティカル・メディカル・ピーリングMicroderma Infusion Facial／マイクロダーマ・インフュージョン・フェイシャルIPL Permanent Hair Removal／IPL 永久脱毛Mesona-J Facial／メソナJ美顔フェイシャルRF Lymphatic Massage／RFリンパマッサージRF Lift Up Facial／RFリフトアップフェイシャルFree Consultation

●Request the date & Time of the treatment:
*Closed On Sundays
First Choice： ---9:00am〜9:30am〜10:00am〜10:30am〜11:00am〜11:30am〜12:00pm〜12:30pm〜1:00pm〜1:30pm〜2:00pm〜2:30pm〜3:00pm〜3:30pm〜4:00pm〜4:30pm〜(LAST)

Second Choice： ---9:00am〜9:30am〜10:00am〜10:30am〜11:00am〜11:30am〜12:00pm〜12:30pm〜1:00pm〜1:30pm〜2:00pm〜2:30pm〜3:00pm〜3:30pm〜4:00pm〜4:30pm〜(LAST)

Third Choice： ---9:00am〜9:30am〜10:00am〜10:30am〜11:00am〜11:30am〜12:00pm〜12:30pm〜1:00pm〜1:30pm〜2:00pm〜2:30pm〜3:00pm〜3:30pm〜4:00pm〜4:30pm〜(LAST)

●Number of customers:
---One personTwo persons

●If you wish to come with another person, please write his/her name here. Please feel free to ask questions or make certain requests for the treatment.