Schedule A Cosmetic Consultation

Schedule a Cosmetic Consultation

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 Phone*

Your Email*

Your Date of Birth*

Insurance Type (ex. Blue Cross Blue Shield)

Request Service or Treatment*

Request a Date

Request a Time
 Morning Afternoon Either Morning or Afternoon

Additional Notes

 

Note: All cosmetic services are performed at our Peoria location.

*required