Pre-treatment registration for Cosmelan® depigmentation

This form helps us determine your skin’s eligibility and prepare this depigmentation protocol safely.

Estimated time: 4-6 minutes.

Your information is confidential.

Complete your cosmelan pre-registration here

Cosmelan® is a professional depigmenting treatment that helps improve dark spots and uneven skin tone. Results develop over time and depend on consistency, sun protection, and proper at-home care. Please be sure to read the Informed Consent for Cosmelan® treatment and our Appointment Booking, Deposit, and Cancellation Policy.

New Customer: Cosmelan pre-registration (form)

Customer information


Your stain (rating)


Contraindications and health (Cosmelan)


Sun, habits and adherence (most important)


Recent procedures (compatibility)


Preferences and notes


Consents and authorizations


If you have any questions…

You can clarify any doubts related to registering for Cosmelan treatment by contacting us directly. You’re in good hands!

Personalized facials with professional diagnosis. Real results, no exaggeration.

Tampa, Florida

New registration (Form)