Today Is The Day Contact Us CHOSEN NAME First Name Last Name LEGAL NAME * First Name Last Name PRONOUNS * EMAIL * PHONE * (###) ### #### ADDRESS * Address 1 Address 2 City State/Province Zip/Postal Code Country DATE OF BIRTH * MM DD YYYY SERVICE INTERESTED IN GRS Clearing Face Electrolysis Body Electrolysis Revisionary hair removal from neovaginal canal (post surgery) Other DO YOU HAVE HEALTH INSURANCE? * *We can bill directly to most insurance providers. Yes, I have health insurance No, I will be paying out of pocket MESSAGE Thank you for contacting Willamette Valley Electrolysis!We will respond to your inquiry as soon as possible