whwny.com

Free Consultation

whwhwnyadmin September 18, 2015 0 0

Scheduling a consultation may be done 24/7 through our automated form. Please complete the form below with complete details and hit submit. You will receive a call back from the doctor’s scheduling assistant within 24 hours. If your form is submitted over the weekend it will be responded to in the order it was received the following Monday.
Our assistant will be able to discuss the removal process with you and answer any questions you may have. You also have the opportunity to ask questions of the doctor in advance of the procedure.

Name

Phone

Date of Birth

Email ID

Ethnicity

Skin Tone

Number of Tattoos getting removed or lightened

Describe your Tattoo(s) for removal

Do you know what inks (brand) were used for your tattoo?

If Yes, please list

Where did you have your Tattoo(s) done?

Have you had any Tattoo removal before?

If yes, please indicate who performed the removal

If yes, please indicate your level of satisfaction with the removal

List any specific questions your would like to ask the doctor

When do you wish to start your removal process?

How do you plan to finance your removal?

How did you hear about us?

When is the best time to reach you?

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Phone Number*
Message*

whwny.com

Free Consultation

whwhwnyadmin

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