NEW CLIENTS

Begin your aesthetic journey with a personalized experience designed around you. During your first visit, we take the time to understand your goals, assess your needs, and create a treatment plan tailored to your vision. From consultation to care, every detail is thoughtfully curated to ensure you feel confident, comfortable, and beautifully supported from day one.

Complete the intake form to schedule an appointment

01 | FORM

FORM

Personalized Aesthetic Care & Customized Treatment Plans in Grand Rapids, MI

Name

Number

Birthdate

Occupation and Employer

Who can we thank for referring you to our office?

Emergency Contact; Please Include Name & Number

Address; include City, State and Zip

Wrinkle Relaxers: Botox, Dysport, Xeomin, Jeuveau & New Longest Lasting - Daxxify

I get treatments 1 or 2 times a year I get treatments 3 or 4 times a year It has been longer than 1 year I would like information only Haven't had - would like a treatment Not Interested

Filler for smile lines, add volume to lips, cheeks, hands etc:

Skincare Products - I Primarily Use

Medical Grade Products Drug & Department Store Products

What Medical Grade Product Line do you use?

Your first appointment will take the longest. It is important we allow adequate time. Select what you would like to schedule.

Consult Only – No Treatment: 45 min Consult + Botox Treatment: 1 hour Consult + Filler Treatment: 1.25 hours I would like something not listed I have an appointment for Lash and/or Brow Service Facial Service: 1.25 hrs Existing Client - updating information

When you look in the mirror does your eye go to a certain area? If so, what bothers you most?

Please provide information to help us accommodate your scheduling preferences. We will do our best!

20 Payment Options NO FEE when using Debit Card - HSA Card (with PIN#) - Check or Cash Credit Card Payments Are Accepted However, the fee associated with your card will be charged to your card - average fee is 3%*

I have read and understand the confirmation / Cancellation Policy

NEW CLIENTS

Personalized Aesthetic Care & Customized Treatment Plans in Grand Rapids, MI

03 | INJECTABLES

03 | INJECTABLES