If you are interested in getting Laser or BBL treatment, please fill out and submit this medical history form, Fitzpatrick skin type form, and either laser or bbl consent form. There are two different forms for Laser and BBL--please choose accordingly. All of these forms are located at the "Forms" tab on the website. (
) Filling out and submitting all these forms before coming to the office will waive the $250 consultation fee.
G2J Clinic Inc,
5150 Graves Ave. San Jose, CA 95129
Date of Birth
Reason for consultation
Brown spots or sun damage
Enlarged blood vessels
Fine lines or wrinkles
Flushing of the skin
Skin texture or scars
Page 1 of 2
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service