Virtual Consultation Form Scottsdale & Phoenix, AZ

FREE Virtual Treatment Plan

Simply submit our online aesthetic analysis form including photos of your face and skin, along with details of your aesthetic and health goals. We will send you a tailored treatment plan recommendation in a “Year-at-a-Glance” format to best address your needs, all from the convenience of your home.

All fields marked with * are required and must be filled.

Please select the types of Free Treatment Plans you would like to receive. (Select all that apply)*

Injectables Plan (Filler, Botox, Biostimulators)

Skin Health Plan (Skincare & Skintreatments)

Wellness (Hormones, Weighltoss & Peptides)

What is your primary motivation for seeking treatment?*

What city do you live in?*

State*

Do you have an upcoming event or vacation you want to look or feel your best for?*

Yes, its in less than 3 months

Yes, its at least 6 months away

No event, I’m seeking an ongoing routine to maintain

Birthday*

Take Photos

Please stand in front of a window and take two photos without any makeup. filters or facial expressions.

All fields marked with * are required and must be filled.

Facing the camera (anterior)

Drop files here or

Max. file size: 50 MB.

Looking to the side (Profile)

Drop files here or

Max. file size: 50 MB.

Aesthetic Goals and Outcomes

All fields marked with * are required and must be filled.

What are your favorite facial features?*

Describe your primary aesthetic concerns:*

List any treatments you would like to know more about:*

Describe the ideal outcome you would like to achieve from aesthetic treatments.*

Do you have an injector preference?*

Select the option that works best with your social calendar and budget for injectable treatments?.*

A single balancing appointment that front loads your treatment plan to get faster results on your first visit ($3100 – $4500)

A Step-wise injectable approach with segmented areas and filler appointments spread out every 3-4 months until the goal outcome is achieved ($2100)

A single procedure (botox or lips) to start off with ($468 -$650)

All fields marked with * are required and must be filled.

What does your ideal health look and feel like?*

On a Scale of 1-5, how committed are you to making changes right now?*

Do you prefer a natural or pharmaceutical approach—or both?*

Natural approach with supplements and peptides

pharmaceutical approach

Both

All fields marked with * are required and must be filled.

First Name*

Last Name*

Phone*

Email*

Virtual Consultation Form

Perfect Dose