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Silk'n Hair Removal System - October 2018
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1.
Please tell us your age:
(Required.)
< 18
18 - 30
31 - 40
41 - 50
> 50
*
2.
Please tell us your gender:
(Required.)
Male
Female
*
3.
To determine your eligibility to test this product, please answer the questions below.
(Required.)
Yes
No
Are you Pregnant or nursing?
Yes
No
Have you been exposed to tanning machines or unprotected sun
bathing in the in last 28 days?
Yes
No
Do you have a history of keloid scar formations?
Yes
No
Any known sensitivity to light or taking medication making you
sensitive to light, including non-steroidal anti-inflammatory agents?
Yes
No
Have you treated with Accutane within last 6 months?
Yes
No
Do you suffer from epilepsy?
Yes
No
Have you received radiation or chemotherapy treatment in the past 3
months?
Yes
No
Do you have an active implant, such as pacemaker, incontinence
device, insulin pump, etc.?
Yes
No
Do you have eczema, psoriasis, lesions, open wounds or active
infections, such as cold sores in the area being treated?
Yes
No
Do you have a history of skin cancer or area of potential skin
malignancies?
Yes
No
The hair removal systems work differently depending on skin tone and hair color. Please indicate in the next question which number most closely resembles your skin tone.
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4.
Please select the number that most closely matches with your skin tone
(Required.)
1
2
3
4
5
6
Please indicate in the next question which hair color most closely resembles your NATURAL hair color.
*
5.
Please select the number that most closely matches your NATURAL hair color.
(Required.)
1
2
3
4
5
6
*
6.
Please complete the information below to qualify for this opportunity.
(Required.)
Name
*
State/Province
*
Country
*
Email Address
*
Phone Number
*
7.
Are you currently a registered member of our community?
(Required.)
Yes
No
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