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

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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