Virtual Care Intake Form
Virtual Care via email, audio and video conferencing has privacy and security risks that your health information may be intercepted or unintentionally disclosed. We want you to understand this before we proceed.
Online Virtual Care Intake – Click Here To Proceed
PDF Form Download – Click here to view
Download and/or Print to fill out and send to email addresses listed at the bottom of the document.
Healthy Image Patient Consent Forms
Click to View
Botulinum Toxin Treatment for Facial Wrinkles – Botox, Dysport and/or Xeomin
Fraxel Laser Treatment
Hyaluronic Acid Fillers
Laser and Light Based Hair Reduction
Platelet Rich Plasma (PRP) Injections
Vascular and Pigmented Lesions