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Other Information (optional)
Medical Specialty:	SelectDermatologyGeneral SurgeryOB/GYNOphthalmologyOral/MaxillofacialPlastic SurgeryPrimary Care MD/DO PA/RN Spa Other
Do you currently own/lease any lasers?	Yes No
Please provide make(s) and model(s):
Procedures you perform, or plan to perform: (Hold down the Ctrl button on your keyboard and click to make multiple selections)	Select from list below Acne scar resurfacing Age spots and other pigmented lesion removal Hair Removal Non-Ablative Rejuvenation Pseudofolliculitis Barbae(PFB) treatment Skin Resurfacing/Wrinkle Removal Tattoo Reduction Vascular Lesion Removal
Aerolase lasers that interest you:	LightPod Era (2940nm) LightPod Neo (1064nm)
Estimated Timeframe for Purchase/Lease of Laser:	Select Immediate 3 months 6 months 12 months >12 months
Other Information / Comments / Requests: