Video Consultation Form
Welcome to Ginille Beauty Aesthetics! We are thrilled to have you as a new patient and look forward to helping you achieve your beauty goals. As part of our commitment to providing personalized care, we conduct comprehensive consultations before your appointment. Here's how the process works: Once we receive your video, completed intake form, and payment, our provider will review the information and create a personalized video response. In this video, we will discuss our recommendations and start developing your treatment plan. Additionally, you will have access to our library of detailed videos about each treatment we offer, including pre-and post-care recommendations and what to expect during your treatment. We are excited to embark on this journey with you and are here to answer any questions you might have along the way. Thank you for choosing Ginille Beauty Aesthetics.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Upload your video:
Please record a video where you discuss your aesthetic concerns and goals. For the best quality, stand in front of a window, facing the window to ensure good lighting. This will help us see your features clearly. Previous Procedures and Questions: In your video, kindly inform us of any previous procedures you've undergone. Also, feel free to include any questions or concerns you might have about your treatment options.
Upload Video
*
Browse Files
Drag and drop files here
Choose a file
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of
Submit Your Payment
A consultation fee of $50 is required, once you submit this form you will receive an email with in 1-2 business days with your invoice.
Complete the intake form
We request that you fill out the patient intake form, which you can find in your patient portal on the Jane app these will be emailed to you once this form is completed. Please allow 1-2 business days for your intake form to be emailed to you.
Please see the link below for information on treatments/ pre and post care.
Youtube
Provider you would like to see
Please Select
First Available
Ginille Brown NP
Lauren Medina RN
Niani Conerly (Dermatology NP)
Ashley Chiu RN
Camay Cooper (Esthetician)
How soon are you looking to receive treatment?
Please Select
Within one week
This month
Next 3 months
Within a year
What treatments are you interested in scheduling?
Please be assured that your video consultation will be kept strictly confidential. It will not be shared on any social media platforms and will be used solely for your medical records to ensure your privacy is maintained
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