Appointment Request
SECURE YOUR JULY SPOT EARLY
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number
Format: (000) 000-0000.
Email
*
example@example.com
What service are you interested in?
*
Neurotoxin treatment with facial analysis (60 minutes)
Lip flip with facial analysis (45 minutes)
Gummy smile reduction with facial analysis (45 minutes)
TMJ treatment with facial analysis (60 minutes)
Hyperhidrosis treatment (60 minutes)
Lip filler with facial analysis (60 minutes)
Cheek filler with facial analysis (60 minutes)
Chin filler with facial analysis (60 minutes)
Hyaluronic acid filler dissolving (60 minutes)
Medical weight loss (60 minutes)
Peptide therapy (60 minutes)
Complimentary In-person Consultation for Neurotoxin or Filler (15 minutes)
Complimentary Virtual Consultation for Neurotoxin or Filler (15 minutes)
In-person Consultation for Medical Weight Loss or Peptide Therapy (15 minutes)
Virtual Consultation for Medical Weight Loss or Peptide Therapy (15 minutes)
NOTE: Appointment times may vary depending on the treatment and individual needs. Appointment times may be shorter or longer than what is stated above. Please use the listed time duration as an estimate only.
Reserve your appointment day and time
*
Don't see a day or time that works? Let me know what works for you and I may be able to accommodate!
How did you hear about us?
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Friends or family
Social media
Website
Acknowledgement
I acknowledge that booking this appointment or consultation is solely to reserve a date and time. I understand that all treatments require an appropriate consultation and medical assessment prior to approval. Booking does not guarantee that I will receive treatment, as eligibility and recommendations will be determined at the time of consultation. I also understand that once the secure, HIPAA-compliant booking portal is available on July 1, 2026, a notification will be sent with all required intake forms, consent forms, and any applicable deposit request, which must be completed prior to my appointment.
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