Empire Aesthetic Center Order Form

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Your Phone Number*

Format: (000) 000-0000.

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Patient Name (Treatment credit will be applied to this patient's account)*

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THIS SALE HAS ENDED

We're sorry, this special is no longer available. Sign up for our email list or follow us on social media to be the first to learn about our next great offer.

Important Offer Details, Terms & Restrictions:

There is a total limit of one (1) discounted product per patient. Products purchased in excess of the limit will be refunded.
Orders are for PICKUP ONLY.
Your order will be prepared within 2 business days, and we will contact you at the number provided to let you know when it's ready.
Want to purchase one of our current MOXI or PEEL specials to get a FREE Lip Drink or HydroPure? Call us at 661.825.4569 to purchase and schedule your treatment!
Offer ends 3/16/2026 at 11:59 p.m.

By purchasing this special, you acknowledge that you have read and agreed to these terms.

My Product*

Jane Iredale LipDrink Lip Balm SPF 15

Regularly $25 - Think of this as your essential daily insurance policy for your lips. Unlike standard waxes that just sit on the surface, LipDrink is a powerhouse of antioxidants and botanicals. Available in 4 delicious colors, it provides broad-spectrum SPF 15 protection while lemon peel oil and green tea extract soothe and shield your skin from environmental damage. It feels incredibly light, smells like fresh citrus, and keeps your lips from thinning or aging due to sun exposure.

$18.75 Color

Jane Iredale HydroPure Hyaluronic Acid Lip Treatment

Regularly $46 - If you struggle with dryness and irritation, this is your new holy grail. This treatment is formulated with Hyaluronic Acid to pull moisture deep into the skin, creating a visibly firmer and smoother appearance. It doesn’t just mask dryness; it actually improves the texture of your lips over time.

$34.50

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