top of page
1066 The Queensway, Etobicoke, ON M8Z 1P7
Client Log in
Back to Forms
What specific cosmetic issues are you concerned about? (check all that apply)
Fine lines and wrinkles
Dark under-eye circles
Sagging skin (jowls, “turkey neck” etc…)
Crow’s feet (wrinkles around eyes)
Dark spots (aka sun spots or age spots
“Eleven’s” (vertical lines in between eyes)
Have you tried any products/treatments in the past to fix these concerns? If so, please share:
How would you like to look after treatment? (check all that apply)
I want to look less tired
I want to look less angry
I want to look less sad
I want a less saggy appearance
I want to look more youthful
Would you like to sustain this look after you achieve it?
How long have you been thinking about getting aesthetic treatment?
Past few days
Past few weeks
Past few months
Is there any specific reason or event why you are interested in treatment now?
Thanks for submitting!
bottom of page