Fill out the form below to schedule your cosmetic (medi-spa / surgical) consultation. We will call you back to confirm your appointment. Click here to book a spa appointment.
Your Name (First and Last)*
Your Date of Birth*
Insurance Type (ex. Blue Cross Blue Shield)
Request Service or Treatment*
---Advanced Facial PeelBreast EnhancementBotox CosmeticCellulazeDermaflageEyelid SurgeryFaceliftFacial Laser ResurfacingJuvederm XCLaser Vein TherapyLaser Hair ReductionLaser Tattoo RemovalLatisseLiposuctionNose SurgerySmartLipoTummy TuckVoluma XCOther
Request a Date
Request a Time
Morning Afternoon Either Morning or Afternoon
Note: All cosmetic services are performed at our Peoria location.