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COSMETIC INTEREST QUESTIONNAIRE 150 Lakeview Circle Covington, La 70433 985-892-3376 NAME:_______________________________________________ DATE___________________ EMAIL ADDRESS:_______________________________________ PHONE #________________ Would you like to receive emails regarding cosmetic services and specials? Y N Please check all that are of interest or concern to you Please circle any of the following that you would like more information on: Hydrafacial Microdermabrasion Chemical peel Hair Loss SkinCare Products Unwanted Hair Skin Tightening Make Up Dermaplaning

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Page 1: C O S M E T I C I N T E R E S T Q U E S T I O N N A I R E

COSMETIC INTEREST QUESTIONNAIRE

150 Lakeview Circle Covington, La 70433 985-892-3376

NAME:_______________________________________________ DATE___________________

EMAIL ADDRESS:_______________________________________ PHONE #________________

Would you like to receive emails regarding cosmetic services and specials? Y N

Please check all that are of interest or concern to you

Please circle any of the following that you would like more information on:

Hydrafacial Microdermabrasion Chemical peelHair Loss SkinCare Products Unwanted Hair

Skin Tightening Make Up Dermaplaning

E xpe c t h i gh e r , mor e i n t r i c a t e t r i c k s

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