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**COSMETIC MODEL REGISTRATION**

**COSMETIC MODEL REGISTRATION**

Once you complete the registration, you may proceed to booking your appointment. All information is secured with the highest HIPAA compliant security. 

HIPAA

Compliance

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    ONCE BOOKED: Appointments cannot be rescheduled or cancelled, and your booking fee will be forfeited if you are unable to attend. **Your appointment is not confirmed and no payment will be taken until you have completed the entire form.**
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    • Wrinkle Assessment and treatment : OCTOBER 10, 1:00pm
      Wrinkle Assessment and treatment : OCTOBER 10, 1:00pm

      Full face: wrinkle assessment, consultation and treatment

      $270AUDRemoveEdit
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    • Wrinkle Assessment and treatment : OCTOBER 10, 1:30pm
      Wrinkle Assessment and treatment : OCTOBER 10, 1:30pm

      Full face: wrinkle assessment, consultation and treatment

      $270AUDRemoveEdit
      Back
    • Wrinkle Assessment and treatment : OCTOBER 10, 2:30pm
      Wrinkle Assessment and treatment : OCTOBER 10, 2:30pm

      Full face: wrinkle assessment, consultation and treatment

      $270AUDRemoveEdit
      Back
    • Wrinkle Assessment and treatment : OCTOBER 10, 3:00PM
      Wrinkle Assessment and treatment : OCTOBER 10, 3:00PM

      Full face: wrinkle assessment, consultation and treatment

      $270AUDRemoveEdit
      Back
      Total cost $0.00AUD
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      Please select all that apply
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      You cannot have treatment if you are having a baby. might be pregnant or are breastfeeding.
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      SIGNATURE
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      DO NOT USE FILTERS.
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      IF WE CANNOT SEE YOUR FACE CLEARLY, YOUR APPOINTMENT WILL NOT PROCEED
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      IF WE CANNOT SEE LINES, WRINKLES OR FOLDS IN THE PHOTOS, YOUR APPOINTMENT WILL NOT PROCEED
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      SIGNATURE
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      Please make sure you are comfortable in a group training environment.

      What does the training treatment involve?

      Your practitioner has completed theoretical cosmetic injection training and will be attending Dermal Distinction Academy for practical training. You have been selected as their model patient and will receive treatment under the guidance of our experienced trainer.

      The training environment

      Treatment takes place in a group learning environment. Other practitioners and patients will be present, and multiple practitioners may participate in your facial assessment.

      Due to limited space, support people cannot attend the training room. If you feel you cannot attend without a support person, this setting may not be suitable for you.

      Treatment results

      Your treatment will be individually planned according to your facial anatomy, medical history and treatment goals, with safety and appropriate clinical outcomes as the priority.

      As with any cosmetic injectable treatment, results vary and further treatment or adjustment may be required after 14 days. Any additional treatment would need to be arranged with your own treating practitioner at your own expense.

      Because treatment is provided as part of supervised clinical training, it is offered at a significantly reduced fee compared with standard private practice fees, typically valued at approximately $750-$1250.

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      IMPORTANT!! PLEASE WATCH THE VIDEO BELOW.

      You cannot proceed without watching the video.



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    COSMETIC MODEL REGISTRATION
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