Consultation Request Form

Please read before filling out the form!

If you’re interested in scheduling a consultation for electrolysis, please complete the consultation request form below. At this time, we are only offering the areas and hours specified on the form. If you have any questions, feel free to reach out through text or email.

You will be contacted via email, so please check your spam folder if you don’t receive a response within 7 days. We look forward to working with you!

Name *

First

Last

Phone Number *

Email *

Hair you would like to get removed (choose all that apply) *

• Abdomen/Below Belly Button
• Breasts/Areolas
• Chin/Neck (we do *not* treat peach fuzz)
• Ears
• Eyebrows
• Fingers/Toes
• Gender Affirming/Surgery Related
• Hairline
• Hormonal/PCOS Induced Hair Growth (face, breasts/chest, neck, torso, etc.)
• Sideburns/Cheeks (we do *not* treat peach fuzz)
• Underarms
• Upper Lip (we do *not* treat peach fuzz)

Previous Electrolysis or Laser?

Availibility (choose all that apply) *

• Monday 8 am – 12 pm
• Monday 2 pm – 6 pm
• Tuesday 9 am – 1 pm
• Tuesday 3 pm – 7 pm
• Thursday 9 am – 1 pm
• Thursday 3 pm – 7 pm
• Friday 8 am – 12 pm
• Friday 2 pm – 6 pm

If you need a very specific time (e.g. Thursdays after 5:30 only) please write in comments below!

Comments

How were you referred to us?

Please confirm that you have read and agree to the following statement: *

• Cape Fear Electrology only provides electrolysis on the areas listed above at this time. We DO NOT currently offer legs, bikini, backs, chest, arms, or peach fuzz. By checking this box, you understand that if you book an appointment for a service that is not offered, you will be charged for the full appointment and turned away. Please contact us if you are unsure or have any questions. Thank you!

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