595 Elm Place, Suite 208
Highland Park, IL 60035

847-681-8821

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New Patient Forms

DIRECTIONS: Please click which form you need to fill out below. Once you click the form link, it will jump to the part of the form you need to fill out. Please fill out all of the fields and click submit. Thank you in advance for doing your best in answering the questions on your form.

 

 

COSMETIC/SKIN CONSULTATION HISTORY

 

Verification

 

FEMALE HEALTH HISTORY

 

Verification

 

MEN’S HEALTH HISTORY

 

Verification

 

FEMALE HAIR LOSS HISTORY

 

Verification

 

MALE HAIR LOSS HISTORY

 

Verification

 

SKIN TYPING FORM

  • If your score is:Your skin type is:
    0 – 31
    4 – 72
    8 – 113
    12 – 154
    16 – 195
    20 – 246
 

Verification

FreshSkin Monthly Specials

skin rejuvenation

Be uniquely
you - confident
and beautiful
LEARN MORE

weight loss

Get the body
you’ve always
wanted
LEARN MORE

products

A brand new
you without
invasive
surgery
LEARN MORE

595 Elm Place, Suite 208
Highland Park, IL 60035
847-681-8821