Returning Botox, Dermal Filler & Hyperhidrosis patients

Name*
First Last
Phone*
cell phone preferred
Email*
Treatment Request*
- BOTOX® Cosmetic
- BOTOX® for Underarm Sweating
- BOTOX® for Palm Sweating
- Dermal Filler Treatment
What areas are you wanting to treat? Please check as many as you want*
- cheek lift
- cheek volume
- smile lines
- edges of my mouth are down turned
- lip volume
- lip definition
- smoker's line
- temple sinking or hollowing
- lower lid hollows or tear troughs
- lower lids are sagging or baggy
- upper lids are sagging
- chin
- jowls or jawline refinement & definition
- stronger jawline
- forehead lines
- crows feet
- brow lift
- straighten nose
- earlobe creases
- other
If choosing BOTOX® Cosmetic, who would you like to perform the treatment?
- Dr Minuk (available Monday, Wednesday, Friday 8:30AM - 12:30PM; Tuesday & Thursday 8:30AM - 4:30PM)
- Carolyn Nurse Injector (available Monday, Tuesday and Thursday 8:30AM - 4:30 PM)
- Danielle Nurse Pratitioner (available Tuesday, Wednesday and Friday 8:30AM - 4:30 PM)
Preferred Date*
Date Format: MM slash DD slash YYYY

SATURDAY BOTOX TREATMENTS AVAILABLE:
NURSE INJECTOR CAROLYN: March 13, April 17, May 8
NURSE PRACTITIONER DANIELLE: March 20, April 10, May 15
Preferred Time*
I wish to receive information on promotions, new treatments and procedures.
- Yes
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.

We are open to Medical and Cosmetic patients and treatments. View our COVID-19 policies.