SUBMIT APPOINTMENT REQUEST FORM

You are one step closer to getting lice free!

After you submit this appointment request form, a member of our customer care team will text or call you back (based on your preference) within 15 minutes or less to confirm availability for your requested day and time.

We are by appointment only. A $25 per person appointment retainer deposit is required to lock in your appointment so that we can assign a certified head lice technician to your family. This deposit will be credited back towards the cost of your head screen or treatment when we check you out. We will text and email a link to pay your appointment retainer deposition directly through our square payment processing system so that we do not have to obtain any of your credit card information.

Once the appointment retainer deposit is paid, we will confirm back to you that it has been received and then officially book your appointment in our system and email your appointment confirmation along with our answers to common questions.

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Parent/Guardian Information

First Name

Last Name

Cell Phone

Name of family members that need to be treated for sure:

First & Last Name

Relationship

Age

First & Last Name

Relationship

Age

First & Last Name

Relationship

Age

Name of family members that need to be screened:

First & Last Name

Relationship

Age

First & Last Name

Relationship

Age

First & Last Name

Relationship

Age

Preferred day for appointment?

Agree or Decline to Receive Text Messages from Torrance Lice Removal Customer CareCheck One

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SUBMIT APPOINTMENT REQUEST FORM

TORRANCE LICE REMOVAL

TORRANCE LICE REMOVAL-THE SOUTHERN CA LICE EXPERTS