New Client Injectable Inquiry

New Patient Information
Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Email Address
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Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Which provider would you like to see?
How did you find us?

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Who can we thank for the referral?

Digital Storage Authorization and Consent
By submitting this form, I voluntarily authorize Skin! Medical Aesthetics and its affiliated providers, employees, and authorized representatives to collect, store, and process the information I provide, which may include personally identifiable information and health-related information. I understand that my responses may be transmitted electronically and stored within secure internal systems, including encrypted cloud-based platforms such as Google Drive or similar technologies used for administrative and care coordination purposes.I acknowledge that authorized personnel, including patient coordinators and clinical staff, may access this information solely for legitimate business and healthcare operations, including appointment scheduling, consultation preparation, follow-up communication, treatment planning, and administrative tracking.I understand that while Skin! Medical Aesthetics implements reasonable administrative, technical, and physical safeguards consistent with applicable privacy and HIPAA standards to protect the confidentiality of my information, electronic transmission and cloud-based storage systems may carry inherent risks and absolute security cannot be guaranteed.By submitting this form, I expressly consent to the collection, storage, internal sharing, and use of my information for the purposes described above and authorize Skin! Medical Aesthetics to contact me via phone, text message, or email regarding scheduling, consultations, and services.

Why Choose Skin! Medical Aesthetics

Our Mission:
Here at Skin! our goal is to maintain your natural aesthetic, educate you on skin care treatments, the science behind them, and how they can benefit you. We know that navigating aesthetic treatments can feel overwhelming. Our job is to simplify the options and help you make informed, confident decisions.

Our number 1 priority is skin health. We improve skin tone, texture, and quality by creating personalized treatment plans. If your plan includes injectables, we take a seamless, blended, minimalistic approach to injectables. We want you to look like yourself but brighter, more refreshed, and balanced.

Why a Comprehensive Approach Matters
We don’t just treat one spot, we look at your whole face, neck, and other areas you care about. This gives you the best, most natural results.

As we age, skin changes from hormones, sun, environment, and even weight shifts. Fat pads shrink, bone structure softens, and skin can look dull, tired, or uneven. That’s why a plan (not one-off treatments) is key to real, lasting change.

Our Approach
We usually design treatments in phases:
- Skin Prep – Build a healthy foundation.
- Restore Structure – Replenish areas where support or volume has changed.
- Maintain – Keep your results long term.
Not everyone needs all three phases. We follow this general framework to build comprehensive plans.

Why We’re Different
The aesthetics world is crowded with treatments and products. We cut through the noise by creating a plan just for you, not a generic menu. Think of it as a roadmap for your skin over the next 10–20 years.

Your Choice
Once you have your plan, you choose what fits your goals, comfort, and budget. Nothing is ever forced, we’re here to guide you and empower you with the knowledge to make the best decisions for you. The goal? For people to look at you after treatment and wonder if you’re simply sleeping better or using a new skincare routine.

Our Injectable Pricing Structure

Neurotoxin

Xeomin $12/unit
Dysport $14/unit
Daxxify $14/unit

Biostimulators

Sculptra $850/vial (10% discount if purchasing 3+ vials)
Radiesse $850/syringe (10% discount if purchasing 3+ syringes)
EZ Gel PRF $750 per treatment or $1950 for series of 3.

Dermal Filler

Priced by area, not by syringe.

Area of Treatment	Price	Additional sessions
Forehead	$800
Temples	$1600
Under Eyes	$800
Mid-Cheek	$800
Lateral Cheek	$800
Nose	$1800
Nasolabial Folds	$800
Upper Lip Lines	$800
Lip	$800	Typically 2 sessions
Marionette Lines	$1200
Chin	$800
Jawline	$2800/session	2-4 sessions depending on bone structure
Skin Hydration	$800
Fine Line Correction	$800
Neck Line Correction	$800

WHAT HAPPENS NEXT
Our clinical team will review your history, goals, and photos within 7–10 business days. You’ll receive your personalized assessment by email, followed by scheduling instructions if you’d like to proceed.

If you'd like to schedule an in-person or video consultation after receiving your pre-consultation evaluation, Stephanie our patient coordinator can help you get that scheduled. All in-person/video consultations are $100.

Please text 720-227-1277 or email appointments@skindenver.co with any questions!
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New Patient Information

Digital Storage Authorization and Consent

Why Choose Skin! Medical Aesthetics

Virtual Photo Assessment

We need your photos to assess your facial anatomy and determine if you're a candidate for dermal filler treatment. Please follow the guidelines below and submit your photos.

Now, Tell Us Everything

Medical and Aesthetic History

Comprehensive Treatment Plan

Our Injectable Pricing Structure

Neurotoxin

Biostimulators

Dermal Filler

WHAT HAPPENS NEXT