* By submitting this form you agree to receive e-mails and other forms of communication from Sylvana Institute, Restorasis Health and Restorasis Essentials. You may unsubscribe at any time by using the SafeUnsubscribe link on the bottom of any e-mail you receive or by contacting us at 301-668-0002.
** A complimentary consultation is required prior to receiving this service to ensure the customized selections are appropriate for your skin type. There is no obligation to purchase other products or services.
*** This service is a gift that you may either choose to accept or decline. This service is limited to one per patient. There is no cash value to this service. This service may not be traded for other Sylvana Institute, Restorasis Health or Restorasis Essentials products or services. This service may not be transferred to another person or used in conjunction with any other discounts, complimentary services or products. As with all Sylvana Services, this service will be performed by a highly skilled and professional clinician. There will be no form of refund for this service. This service will not be repeated free of charge for any reason.
**** This offer is valid for one year from submission of form