Preferred Name *

First Name

Last Name

Legal Name

*If different than preferred name

First Name

Last Name

Pronouns *

They/Them

She/Her

He/Him

They/Her

They/Him

Zem

Custom Pronouns

Birth Date *

MM

DD

YYYY

What color is the majority of your unwanted hair? *

Black

Brown

Red

Blonde

Grey / White

Salt and Pepper

What is the cause of your unwanted hair? *

*This info helps me develop a treatment plan specifically for you

I don't know the cause

PCOS

Transgender

Menopause

Heredity

Other

Preferred Appointment Day(s) / Time(s) *

Anytime, any day!

Weekday Morning (Mon-Fri, 8am-11:30am)

Weekday Afternoon (Mon-Fri, 12pm-3:30pm

Weekday Evening (Mon-Fri, 4pm-9pm)

Weekends (Sat-Sun)