Mona Lisa Cosmetic Surgery Center

* Required

1. Sex:

Female Male

2. Skin is:

Oily Dry Combination

3. Skin color is:

Very fair, always burn
Light, but may tan
Light to medium
Medium, rarely burns
Medium to dark (Asian, Hispanic)
Dark (African American), never burns

4. Do you have any food or product allergies?

Yes No

5. Do you have sensitive skin?

Yes No

6. What bothers you about your skin?

Large pores
Acne
Facial lines or wrinkles
Pigmented or age spots
Dark circles around eyes
Moles or skin cancers

7. Have you ever had chemical or laser peels?

Yes No

8. Are you currently using Retin A, Glycolic Acid, Benzoyl Peroxide, Vitamin C, AHA's, or Acne medications?

Yes No

PATIENT TESTIMONIALS

FRACTIONAL LASER

Dr. Kassir proud to announce "New Fractional Laser Tightens Skin with Minimal Downtime".

Please click here to contact our office and schedule your appointment.

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