All Inclusive Recovery Stay
Recover like the beauty icon you are
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
E-mail
*
example@example.com
Instagram ID
Check-in Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Check-out Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Is there a Companion?
Yes
No
Companion's Gender
Female
Male
Companion's Name
Room Type
Shared Room
Private Room
Private Care - Personally Booked Hotel/ Air bnb if you choose this, please provide the hotel name and address below in additional comments)
Airline
American
British Airways
Delta
Frontier
Jetblue
Southwest
Spirit
United
Virgin Atlantic
Arrival Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Arrival Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Airline
American
British Airways
Delta
Frontier
Jetblue
Southwest
Spirit
United
Virgin Atlantic
Departure Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Departure Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Procedure
BBL/Lipo
Tummy tuck
Breast Aug
Mommy Makeover
Combination Procedure
Other
Surgery Center
Surgeon
Pre-Op Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Surgery Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Added Services
Bilingual Pre Op Companion - $100
Overnight Nurse Surgery Day - $100
Massage - Single - $40
10 Massage - Basic Package - $350
Post Op Diva Drip - $175 - IV Drip vitamins and hydration
Signature Facial - $150 - 24k with LED light therapy
Diamond Microdermabrasion Facial - $185 - with HydroJelly mask
Perfect Peel - $300 - Chemical Peel Facial includes after care
Microblading Brows - $300
Combo Brows - $350
Ombre Brows - $325
Brows - Touch Up - $75
Wax / Tint Brows - $30
Strip Lashes - $20
Classic Lashes - $150
Hybrid Lashes - $170
Volume Lashes - $190
Mega Volume Lashes - $200
Teeth Whitening - $100- 60 minutes
Teeth Whitening - $200 - 90 minutes
Tooth Bling - $130 - Disco Ball Style ( 1 tooth)
Tooth Bling - $100 - Swarvarski Single Stone ( 3 stones)
Lip Fillers - $300 - .5 ML - Non Invasive
Lip Fillers - $350 - 1 ML - Non Invasive
Lip Blush - $300
How did you hear about us?
Food Allergies
Emergency Contact & Phone #
Any additional comments/ questions/ concerns that we should know?
Submit
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