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Returning Clients
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Treatment Request
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Please note:
Consultation
is required before booking a treatment.
Select
❤ Skin Booster / Lip Filler Promo ❤
BBL Photorejuvenation
Botox® / Dysport®
Chemical Peel
Emsculpt Neo®
Filler
Laser Hair Removal
Microdermabrasion with BelaMD
Micro-Needling
PRP Facial Rejuvenation
PRP Hair Rejuvenation
Sclerotherapy
Sculptra®
Skin Booster
Other
What areas are you wanting to treat? Please check as many as you want
*
Abdomen
Arms
Buttocks
Calves
Love Handles
Thighs
What areas are you wanting to treat? Please check as many as you want
*
Brow Lift
Cheek Lift
Cheek Volume
Chin
Crows Feet
Earlobe Creases
Forehead Lines
Jowls or Jawline Refinement & Definition
Lip Definition
Lip Volume
Lower Lids sagging or baggy
Lower Lid hollows or tear troughs
Mouth edges are down turned
Smile Lines
Smoker's Line
Straighten Nose
Stronger Jawline
Temple sinking or hollowing
Upper Lids sagging
Other
What areas are you wanting to treat? Please check as many as you want
*
Abdomen
Arms
Back
Back & Chest
Back & Shoulders
Back of Neck
Bikini
Chin
Face
Full Legs
Lip & Chin
Lower Legs
Sideburns
Underarms
Upper Lip
Other
Preferred Date
*
(Saturday treatments available)
MM slash DD slash YYYY
Preferred Time
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Early Morning
Mid Morning
Late Morning
Early Afternoon
Mid Afternoon
Late Afternoon
Early Evening *Wednesday’s Only*
Preferred Treatment Provider (Injectable Services)
Select
Danielle, NP
Laura, RN
No preference 🙂
Preferred Treatment Provider (Laser Services)
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Julie K.
Kim H.
Suki S.
No preference 🙂
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