top of page

Please complete this online consultation form:

Choose the characteristics of your skin Required
Are you using Retinoids?

General Medical Questions

Have you used Accutane in the last six month?
Are you using any topical medications?
Have you been diagnosed with Melasma?
Have you been diagnosed with a seizure disorder?
Do you have rosacea?
Have you had botox or fillers in the last 30 days?
Are you currently undergoing treatment for Cancer?
Do you have metal implants or wear a metal retainer?
Please check any of the following that would apply to your skin: Required

Thanks for submitting!

bottom of page