Would you be a new patient or existing patient ?

[[{"field_id":5484,"subrules":{"field_id":5455,"value":"New Patient","operator":"Match"}}],[{"field_id":5486,"subrules":{"field_id":5455,"value":"Existing Patient","operator":"Match"}}]]

What appointment would you like to schedule?

    • [[{"field_id":5487,"subrules":{"field_id":5484,"value":"Injection","operator":"Match"}}],[{"field_id":5489,"subrules":{"field_id":5484,"value":"Tempsure\/ Flexsure","operator":"Match"}}],[{"field_id":5493,"subrules":{"field_id":5484,"value":"Skin Renewal","operator":"Match"}}],[{"field_id":5495,"subrules":{"field_id":5484,"value":"IV Infusion","operator":"Match"}}],[{"field_id":5496,"subrules":{"field_id":5484,"value":"Annual Well Woman Exam","operator":"Match"}}],[{"field_id":5497,"subrules":{"field_id":5484,"value":"Aesthetic Consult","operator":"Match"}}],[{"field_id":5498,"subrules":{"field_id":5484,"value":"Emsculpt NEO","operator":"Match"}}],[{"field_id":5501,"subrules":{"field_id":5484,"value":"Emtone","operator":"Match"}}],[{"field_id":5502,"subrules":{"field_id":5484,"value":"Dermal Fillers","operator":"Match"}}],[{"field_id":5503,"subrules":{"field_id":5484,"value":"Flexsure","operator":"Match"}}],[{"field_id":5505,"subrules":{"field_id":5484,"value":"Neurotoxin","operator":"Match"}}],[{"field_id":5508,"subrules":{"field_id":5484,"value":"Potenza","operator":"Match"}}],[{"field_id":5542,"subrules":{"field_id":5484,"value":"Vitalia","operator":"Match"}}],[{"field_id":5544,"subrules":{"field_id":5484,"value":"Laser Hair Removal","operator":"Match"}}],[{"field_id":5546,"subrules":{"field_id":5484,"value":"Emsella","operator":"Match"}}],[{"field_id":5502,"subrules":{"field_id":5484,"value":"Skinvive","operator":"Match"}}],[{"field_id":6207,"subrules":{"field_id":5484,"value":"Emface","operator":"Match"}}]]

What appointment would you like to schedule?

    • [[{"field_id":5547,"subrules":{"field_id":5486,"value":"Hormone Pellet Insertion","operator":"Match"}}],[{"field_id":5550,"subrules":{"field_id":5486,"value":"Injection","operator":"Match"}}],[{"field_id":5551,"subrules":{"field_id":5486,"value":"Annual Well Woman Exam","operator":"Match"}}],[{"field_id":5553,"subrules":{"field_id":5486,"value":"Repeat Pellet Insertion & Annual Exam","operator":"Match"}}],[{"field_id":5556,"subrules":{"field_id":5486,"value":"Consult","operator":"Match"}}],[{"field_id":5558,"subrules":{"field_id":5486,"value":"IV Infusion","operator":"Match"}}],[{"field_id":5559,"subrules":{"field_id":5486,"value":"Aesthetic Consult","operator":"Match"}}],[{"field_id":5560,"subrules":{"field_id":5486,"value":"Emsculpt NEO","operator":"Match"}}],[{"field_id":5563,"subrules":{"field_id":5486,"value":"Emtone","operator":"Match"}}],[{"field_id":5565,"subrules":{"field_id":5486,"value":"Dermal Fillers","operator":"Match"}}],[{"field_id":5566,"subrules":{"field_id":5486,"value":"Flexsure","operator":"Match"}}],[{"field_id":5568,"subrules":{"field_id":5486,"value":"Medication Follow-Up","operator":"Match"}}],[{"field_id":5582,"subrules":{"field_id":5486,"value":"Neurotoxin","operator":"Match"}}],[{"field_id":5586,"subrules":{"field_id":5486,"value":"Tempsure","operator":"Match"}}],[{"field_id":5589,"subrules":{"field_id":5486,"value":"Vitalia","operator":"Match"}}],[{"field_id":5591,"subrules":{"field_id":5486,"value":"Potenza","operator":"Match"}}],[{"field_id":5593,"subrules":{"field_id":5486,"value":"Laser Hair Removal","operator":"Match"}}],[{"field_id":5595,"subrules":{"field_id":5486,"value":"Emsella","operator":"Match"}}],[{"field_id":5502,"subrules":{"field_id":5486,"value":"Skinvive","operator":"Match"}}],[{"field_id":6207,"subrules":{"field_id":5486,"value":"Emface","operator":"Match"}}]]

Please indicate which injection(s) you are interested in receiving. We offer the following injections in-office.

    • [[{"field_id":5639,"subrules":{"field_id":5487,"value":"SlimShot","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5487,"value":"Super SlimShot","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5487,"value":"Tri-Immune Boost","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5487,"value":"Vitamin D","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5487,"value":"Vita-Complex","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5487,"value":"CoQ10","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5487,"value":"Tirzepatide","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5487,"value":"Mineral Blend","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5487,"value":"Amino Blend","operator":"Match"}}]]

Do you have any metal implants or a pacemaker?

    • [[{"field_id":5490,"subrules":{"field_id":5489,"value":"No","operator":"Match"}}]]

Do you have any metal implants or a pacemaker?

What area were you wanting treated?

    • [[{"field_id":5491,"subrules":{"field_id":5490,"value":"TempSure Envi (Face)","operator":"Match"}}],[{"field_id":5492,"subrules":{"field_id":5490,"value":"TempSure Firm (Body)","operator":"Match"}}]]

Please indicate which area you would like in the appointment notes. We offer TempSure Envi in the following areas.

Please indicate which area you would like in the appointment notes. We offer TempSure Firm in the following areas.

Have you been in the sun, used any retinols, or had a HSV outbreak in the (cold sore) last 2 weeks?

    • [[{"field_id":5494,"subrules":{"field_id":5493,"value":"No","operator":"Match"}}]]

Please indicate which area you would like. We offer Skin Renewal in the following areas.

Please indicate which IV you are interested in receiving in. We offer the following IV Infusions. 

    • [[{"field_id":5639,"subrules":{"field_id":5495,"value":"Get-Up-and-Go","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5495,"value":"Immunity","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5495,"value":"Inner Beauty","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5495,"value":"Reboot","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5495,"value":"Quench","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5495,"value":"Myers Cocktail","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5495,"value":"Alleviate","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5495,"value":"Recovery & Performance","operator":"Match"}}]]

When was your last well woman exam?

Please indicate which service you are interested in discussing. We offer online scheduling for the following consultations.

    • [[{"field_id":5639,"subrules":{"field_id":5497,"value":"Botox","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5497,"value":"Jeuveau","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5497,"value":"Dysport","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5497,"value":"Neurotoxin, unspecified","operator":"Match"}}]]

Do you have any metal implants or a pacemaker?

    • [[{"field_id":5499,"subrules":{"field_id":5498,"value":"No","operator":"Match"}}]]

Do you have any metal implants or a pacemaker?

    • [[{"field_id":5500,"subrules":{"field_id":5501,"value":"No","operator":"Match"}}]]

Please indicate which area you would like. We offer Emsculpt NEO in the following areas. 

Please indicate which area you would like. We offer Emtone in the following areas. 

Are you currently pregnant?

Do you have any metal implants or a pacemaker?

    • [[{"field_id":5504,"subrules":{"field_id":5503,"value":"No","operator":"Match"}}]]

Please indicate which area you would like. We offer FlexSure in the following areas.

Are you currently pregnant?

    • [[{"field_id":5506,"subrules":{"field_id":5505,"value":"No","operator":"Match"}}]]

Please indicate which neurotoxin treatment you would like. We offer the following neurotoxins.

    • [[{"field_id":5639,"subrules":{"field_id":5506,"value":"Botox","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5506,"value":"Dysport","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5506,"value":"Jeuveau","operator":"Match"}}]]

Do you have implants or a any metal pacemaker?

    • [[{"field_id":5508,"subrules":{"field_id":5507,"value":"No","operator":"Match"}}]]

Please indicate which area you would like. What area were you wanting treated?

Do you have implants or any metal pacemaker?

    • [[{"field_id":5543,"subrules":{"field_id":5542,"value":"No","operator":"Match"}}]]

Do you currently have a vaginal or urinary tract infection?

Have you been in the sun, used any retinols, or had a HSV (cold sore) outbreak in the last 2 weeks?

    • [[{"field_id":5545,"subrules":{"field_id":5544,"value":"No","operator":"Match"}}]]

Please indicate which area you would like. We offer Laser Hair Removal in the following areas. 

Do you have any metal implants or a pacemaker?

Would this be your first pellet with our office?

    • [[{"field_id":5548,"subrules":{"field_id":5547,"value":"No","operator":"Match"}}]]

When was your last pellet with our office?

    • [[{"field_id":5549,"subrules":{"field_id":5548,"value":"Less than 1 year ago","operator":"Match"}}]]

Select your gender

Please indicate which injection(s) you are interested in. We offer the following injections in-office.

    • [[{"field_id":5639,"subrules":{"field_id":5550,"value":"Super SlimShot","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5550,"value":"Tri-Immune Boost","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5550,"value":"Vitamin D","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5550,"value":"SlimShot","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5550,"value":"Semaglutide","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5550,"value":"Vita-Complex","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5550,"value":"CoQ10","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5550,"value":"Tirzepatide","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5550,"value":"Mineral Blend","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5550,"value":"Amino Blend","operator":"Match"}}]]

Have you had an annual well woman exam (Pap Smear) with our office before?

    • [[{"field_id":5552,"subrules":{"field_id":5551,"value":"Yes","operator":"Match"}}]]

When was your last well woman exam?

Would this be your first pellet with our office?

    • [[{"field_id":5554,"subrules":{"field_id":5553,"value":"No","operator":"Match"}}]]

When was your last pellet with our office?

    • [[{"field_id":5555,"subrules":{"field_id":5554,"value":"Less than 1 year ago","operator":"Match"}}]]

When was your last well woman exam?

When was your last visit with our office?

    • [[{"field_id":5557,"subrules":{"field_id":5556,"value":"Less than 1 year","operator":"Match"}}]]

Please indicate which consult you would like. We offer online scheduling for the following consultations.

Please indicate which IV you are interested in receiving in. We offer the following IV Infusions.

    • [[{"field_id":5639,"subrules":{"field_id":5558,"value":"Get-Up-and-Go","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5558,"value":"Immunity","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5558,"value":"Inner Beauty","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5558,"value":"Reboot","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5558,"value":"Quench","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5558,"value":"Myers Cocktail","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5558,"value":"Alleviate","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5558,"value":"Recovery & Performance","operator":"Match"}}]]

Please indicate which service you are interested in. We offer online scheduling for the following consultations.

    • [[{"field_id":5639,"subrules":{"field_id":5559,"value":"Botox","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5559,"value":"Jeuveau","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5559,"value":"Dysport","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5559,"value":"Neurotoxin, unspecified","operator":"Match"}}]]

Do you have any metal implants or a pacemaker?

    • [[{"field_id":5562,"subrules":{"field_id":5560,"value":"No","operator":"Match"}}]]

Please indicate which area you would like. We offer Emsculpt NEO in the following areas.

Do you have any metal implants or a pacemaker?

    • [[{"field_id":5564,"subrules":{"field_id":5563,"value":"No","operator":"Match"}}]]

Please indicate which area you would like. We offer Emtone in the following areas.

Are you currently pregnant?

Do you have any metal implants or a pacemaker?

    • [[{"field_id":5567,"subrules":{"field_id":5566,"value":"No","operator":"Match"}}]]

Please indicate which area you would like. We offer FlexSure in the following areas.

When was your last visit with our office?

Are you currently pregnant?

    • [[{"field_id":5583,"subrules":{"field_id":5582,"value":"No","operator":"Match"}}]]

Please indicate which neurotoxin treatment you would like. We offer the following neurotoxins.

    • [[{"field_id":5639,"subrules":{"field_id":5583,"value":"Botox","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5583,"value":"Dysport","operator":"Match"}}],[{"field_id":5639,"subrules":{"field_id":5583,"value":"Jeuveau","operator":"Match"}}]]

Have you been in the sun, used any retinols, or had a HSV (cold sore) outbreak in the last 2 weeks?

Please indicate which area you would like. We offer Skin Renewal in the following areas.

Do you have any metal implants or a pacemaker?

    • [[{"field_id":5587,"subrules":{"field_id":5586,"value":"No","operator":"Match"}}]]

What area were you wanting treated?

    • [[{"field_id":5588,"subrules":{"field_id":5587,"value":"TempSure Firm (Body)","operator":"Match"}}]]

Please indicate which area you would like. We offer TempSure Firm in the following areas. 

Do you have any metal implants or a pacemaker?

Do you currently have a vaginal or urinary tract infection?

Do you have any metal implants or a pacemaker?

    • [[{"field_id":5592,"subrules":{"field_id":5591,"value":"No","operator":"Match"}}]]

Please indicate which area you would like. What area were you wanting treated?

Have you been in the sun, used any retinols, or had a HSV outbreak in the (cold sore) last 2 weeks?

    • [[{"field_id":5594,"subrules":{"field_id":5593,"value":"No","operator":"Match"}}]]

Please indicate which area you would like. We offer Laser Hair Removal in the following areas.

Do you have implants or a any metal pacemaker?

Please select one of the locations below.

Do you have any metal implants or a pacemaker?