• Tox Party + Pop-Up Interest Form

  • Hello Tox Party + Pop-Up friends!

    Please read this fully if you are considering getting any treatment at your upcoming party/pop-up.

    If you are planning to receive treatment at the event, you must complete this form ahead of time.

    If you are even considering treatment, it is highly recommended that you complete this form so we can plan accordingly.

    This form helps us:

    Bring the correct amount of product to the event
    Know which treatments guests are interested in
    Send intake/consent forms ahead of time
    Make the event run as smoothly as possible
    Events can get busy, so completing this form helps us make sure we have enough product, enough time, and the right forms completed before your treatment.

    After submitting this form, you will receive intake/consent forms at the email address you provide. These forms need to be completed prior to treatment. Forms are required annually, so even if you are an existing Head + Heart client, you may still need to complete updated forms.

    After submitting this form, you will be able to sign up for a time slot. We are only guaranteeing 6 slots and it will be first come first serve. If we end up with extra time between treatments, we will try to squeeze people in if possible.

    If you do not complete this form but decide at the event that you would like treatment, we may be able to accommodate you, but guests who completed the form ahead of time will be prioritized. You may also be asked to go last, and we cannot guarantee that your desired treatment or product will be available.

    We always do a mini consultation before treatment at the event. However, if you are wanting a more in-depth consultation or have detailed concerns, we recommend booking a full consultation at the clinic. We have limited time at events and therefore generally are unable to give your the full time or attention for a full consult.

    VI Peels are only offered at parties/pop-ups to guests who have completed this form ahead of time, as we need to know what to bring. Please note that the VI Peel is a medium-depth peel. It may sting during application, and peeling can range from light flaking to full sheet peeling. The most noticeable peeling typically occurs around days 3–5, so please plan accordingly. Please arrive with a freshly cleansed face if you are receiving a peel.

    Feel free to email us with any questions.

    For more information on treatments, visit:
    www.headandhearthealth.com

    Follow us on Instagram:
    @headandheartks

    Email:
    headandheartks@gmail.com

    Phone:
    (785) 592-3800

    Prices are subject to change.

    PRICING:

    Lip Flip: $70

    Daxxify: $6.50/unit
    Please note: Daxxify generally requires about double the units compared to Botox or Dysport.

    Dysport: $10/unit

    Botox: $12/unit

    VI Party Peel: $250
    $200 if done in addition to tox

    B12 shot: $40

    15% off other services scheduled at the party/pop-up

    20% off skincare products purchased at the party/pop-up

  • Format: (000) 000-0000.
  • Are you a current Head & Heart client?
  • Are you planning to receive treatment at the party/pop-up?*
  • What treatment are you interested in?*
  • What do you generally like or are you interested in having treated*
  • Have you had tox before?
  • Do you have a preference on product?*
  • Are you interested in a VI Peel at the party/pop-up?
  • If wanting a VI Peel, which one sounds the most enticing to meet your needs?
  • What are your main skin concerns?
  • What products are you interested in?
  • Are there any product lines you would like me to bring.
  • Are you interested in scheduling a future service at the clinic?
  • Should be Empty: