Shadowing Request
Share your details and preferences to request a shadow day with an experienced injector.
Personal Information
First Name
*
Last Name
*
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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Credentials & Experience
Credentials
*
Please Select
RN
NP
PA
MD
DO
Dentist
License Number
*
License Issuing State
*
Are you currently practicing?
*
Yes
No
If yes, where? Practice name and city
*
Aesthetics Experience
*
Under 1 year
1 to 3 years
3+ years
Experience details
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Your Shadow Day
Package
Individual: $500 (One full shadow day for one participant)
Small Group: $1000 (One full shadow day for a group of up to three participants)
Full Month: $2500 (Up to 10 shadow days within one month for one participant)
Number of participants and their names (Small Group only)
Preferred Dates
*
How would you like to pay?
*
Pay in full
Split payments
How many months would you like to split your payments over?
*
Payment plan duration is subject to approval. Split payments include an additional $50 per invoice.
What do you most hope to observe or learn?
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