* All info is kept strictly confidential
Because of the intimate nature of this experience, spots are extremely limited.
Please complete this application to be considered for one of my VIP VISION DAY clients. Once you’ve completed all the questions hit the submit button. We will get in touch with you to set up an appointment to make sure this is the right fit for you.
If you need additional assistance, please contact me at (203) 855-9714 or email firstname.lastname@example.org
Apply for Your VIP Day!
*indicates required field