Intake Forms

Choose the intake form related to the appointment you are scheduled for. Intake forms must be filled out once a year or if you are receiving a new treatment.

Neuromdulator Treatment or Filler.

If you have an appointment for Botox/Dysport and/or Filler please complete this intake form.

PRP Treatment.

If you are having treatment for hair restoration with PRP or Micro-needling with PRP please complete this intake form

Hyluronidaise.

If you are having filler dissolved please complete this intake form.

Located in the Beautiful Town of Orangeville.

41 Broadway, Unit B, Orangeville, ON, L9W 1J7.