Medical History

Generally speaking, electrolysis is safe for most medical conditions. However, if you have diabetes, high blood pressure, hemophilia, any artificial joints or implants (like a pacemaker), are on Accutane, or are pregnant, be sure to let us know. Usually, we can treat you regardless of these conditions, but we may have to take special precautions and/or may require a note from your doctor declaring that it is safe to treat you.

For your safety, the only areas we cannot treat are the hairs inside the nose and the ear canal.

Your medical history is vital in determining your treatment schedule. This information is kept in the strictest confidence.

Prior to your appointment, please complete the appropriate form below and bring it with you to your consultation or you can email to: [email protected]

Client Health Questionnaire - Electrolysis - for hair removal

Client Health Questionnaire - Electrocoagulation - for skin imperfections

These forms are fillable PDF files that can be saved or printed after filling out online.

If you are seeking mole removal, kindly bring this form to your doctor for their confirmation that it is safe to proceed with the removal. This confirmation is required for mole removal purposes only.

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