Electrologist Data Sheet

You can help greatly by supplying information about your TG-friendly electrologist!  It will be added to the Directory of TG-recommended electrologists.

Items in red are especially important information.

Thank you in advance for your help!

PLEASE COPY ALL OF THE QUESTIONS BELOW INTO YOUR EMAIL and send to host@tsroadmap.com

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1. Electrologist contact information   
Electrologist name(s)  
Company name
Address
City, State, Zip
Phone:
e-mail:
website:
2. Days open (put an X by applicable days)
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
 
3. Hours __ to ___
By appointment only?
4. Electrologist treatment information   
Number of electrologists in office:
Treatment with two electrologists simultaneously available?   
Modality used (%)      
Thermolysis
Galvanic
Blend
Type of probes available:
disposable
non-disposable
insulated
non-insulated
straight
tapered
bulbous
gold-plated
multi-needle galvanic
Electrologist wears a mask.
Electrologist wears gloves.
                                             
5. How you chose your electrologist:
TG referral
Advertisement
Internet
Non-TG referral
Other: 
Was consultation  free?
Were hairs treated?
Were certification/training documents displayed.
6.  Please state your opinion about this electrologist:  

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PLEASE COPY ALL OF THE ABOVE INTO YOUR EMAIL.