Honolulu MedSpa
Laser Hair Removal
Featuring virtually painless Super Hair Removal

Skin Rejuvenation
• Laser 360°
• InstaLift Oxygen Therapy
• HydraFacial™
• Photodynamic Therapy
• Vitalize Peel®

Cellulite Reduction & Body Contouring
Accent™ XL
 Acne
• BLU-U
• Salicylic Gel Peel
• Photodynamic Therapy
 Spot Removal Facials &
Peels		 Injectables
• Botox
• Restylane
• Mesotherapy
 
 
All information provided will be kept confidential and will only be used for the purpose of esthetic treatments at Honolulu MedSpa.

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*Name:
*Date of birth:   *Female   *Male
   
Contact Information
*Mailing Address:
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*How did you hear about us? (Please check one and specify the source)
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Yellow Pages:
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*Which treatment(s) are you interested in (Please check all that apply):
Laser Hair Removal
Current method(s) of hair removal:
Waxing
Tweezing
Shaving
Electrolysis
Depilatories
Other
Skin Rejuvenation (sun/age spots, fine lines & wrinkles, large pore size, uneven skin tone, skin texture)
Cellulite & Fat Reduction
Acne Treatment (active breakouts, acne scarring)
Day Spa Treatments
Facials
Peels
Massages
Spot/Skin Tag Removal
BOTOX®
Restylane®
Mesotherapy (targeted fat reduction: double chin, upper arms, abs, love handles, hips, thighs)
 
Medical History:
Surgical History:
Current Medications:
Medications within past 6 months:
Allergies:
 
Comments/Questions:
 
 
 
 
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Honolulu MedSpa
1650 Liliha St., Ste # 102
Honolulu, HI 96817
808-528-0888
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