Medical Aesthetics Model Application

Medical Aesthetics Model Application
Thank you for your interest in becoming a model for our medical aesthetics training sessions. These treatments are performed by licensed injectors who are currently receiving advanced training, under direct supervision of experienced professionals. Treatments are offered at significantly reduced rates and take place on weekends in a private clinical setting in Pueblo, Colorado. Please complete all fields and include your photo so the injectors we work with can determine suitability for trainings. Please note, your decision to participate implies consent to be photographed or filmed during the procedure for training purposes and marketing. A member of our team will reach out if you’re a good fit for the current training schedule.

©️ 2025, Next Top Injector
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Are you currently pregnant or breastfeeding?*

PregnantBreastfeedingNeitherUnknown
Have you had aesthetic treatments before? If so, please describe which and approximately when.
Do you have any medical conditions or are you taking any medications? Please list.
List all known allergies.
Which treatment(s) would you be interested in modeling for?*

Botox, Dysport, or other neuromodulatorsLip fillerCheek filler or midfacial contouringChin or jawline fillerLaser hair reduction
Please include 1 or more clear, makeup-free photographs of your face. This will help the injectors we work with determine suitability for trainings*

Cancelof
Should be Empty: