Please complete this form to assist us in triaging your laser tattoo removal booking request. The information provided will help our team assess your enquiry, provide accurate booking and treatment information, and support a smooth patient journey from initial consultation through to treatment.

Full name: *

Email: *

Date of birth: *

Contact number: *

How many tattoo's would you like to have treated? *

Where is the tattoo located on your body? *

When did you get your tattoo? This doesn't have to be exact, the year is adequate. *

Was your tattoo performed in Australia, or overseas? If overseas, where? *

Have you had any treatment to your tattoo previously? *

Have you ever had an adverse to laser treatment? *

Please upload clear images of all tattoo's you wish to have treated:

Images are essential for us to triage your request. *

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If you have any questions that we can assist you with, please list them here.

P: (03) 9740 2409 | F: (03) 9740 2889
cosmetic@completeskinspecialists.com.au
www.completeskinspecialists.com.au
@completeskinspecialists