Model Call Interest Form

1

Models must agree to the following if selected- please check each box to indicate you have read and agree to what is listed* This field is required.

Must agree to consent for use of photos and or videos for social media and online.

Must agree to providers full treatment plan if selected Facial Balancing or Full Face Tox.

Full balance is due at time of booking to secure model slot.

2

Name* This field is required.

First Name

Last Name

3

Email* This field is required.

example@example.com

4

Phone Number* This field is required.

Please enter a valid phone number.

5

Please indicate what treatment or treatments you’re interested in fulfilling that day for your appointment. Model fee is listed beside service name.* This field is required.

Facial Balancing- Preservation Filler Package $2500 instead of $3200

Neck or Neck + Decolletege Rejuvenation/ Tightening $1500 instead of $2000

Mini Non surgical BBL for subtle volume enhancement or hip dips $3750 instead of $4500

Non surgical BBL for volume enhancement or hip dips $5500 instead of $6500

6

If you selected more than one service above- let us know which is your top priority

Chin filler, under eye filler, lip filler, Botox for frown lines etc

7

What is your overall goal from receiving treatments?* This field is required.

8

Have you ever had filler or tox in the past?* This field is required.

Yes

No

9

If yes, please give a detailed description to the best of your knowledge- what areas you've had treated in the past and when.

Chin filler, under eye filler, lip filler, Botox for frown lines etc

10

Facing the camera * This field is required.

11

Looking to the left ( profile ) * This field is required.

12

Looking to the right ( profile ) * This field is required.

13

If yes, please describe the type of surgery:

14

Have you had surgery on your face or neck?* This field is required.

No

Yes

15

Do you have implants in your face?* This field is required.

Yes

No

16

Indicate which providers you'd be comfortable being treated by

Tina

Injector being guided and supervised by Tina

Morgen

Irene

17

What Days and Times Are You Generally Available?To help me find a training spot that works for both of us, please share a few different days or date ranges when you’re typically available. Which weekdays usually work for you Any preferred dates or windows that fit your schedule