info@wise-aesthetics.com
(317) 569-6448
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Daxxify®
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Fat Dissolving Treatments
Xeomin®
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HALO®
IPL and BBL Treatments
CoolPeel
Laser Vein Treatment
Laser Genesis
Moxi Laser
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Injectables
Dermal Fillers
Daxxify®
Botox
Fat Dissolving Treatments
Xeomin®
Dysport®
PRP/PRF Treatments
Biostimulators
Thread Lift
Laser Treatments
HALO®
IPL and BBL Treatments
CoolPeel
Laser Vein Treatment
Laser Genesis
Moxi Laser
Laser Hair Removal
Skin Rejuvenation
RF Microneedling
SkinTyte®
Microneedling
Clinical Facials
Glo2Facial
Chemical Peels
Hydrafacial
Wellness
Hormone Replacement
Medical Weight Loss
IV Therapy
Journey Membership
Shop
Alastin
Epionce
ZO Skin Health
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About Us
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Survey
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What area are you most interested in?
*
Face
Body
What are your concern(s)? (Select all that apply)
*
Acne
Contour
Dark circles under eyes
Fat reduction
Hydration
Hyperpigmentation/melasma
Redness
Sun Damage
Skin Laxity
Scars
Tone & texture
Volume loss
Wrinkles & lines
Unwanted hair
What are your concern(s)? (Select all that apply)
*
Acne
Fat reduction
Hyperpigmentation/melasma
Skin Laxity
Scars
Sweat Reduction
Unwanted hair
How would you describe your skin?
*
Combination (Oily & Dry)
Dry (tight or flakey)
Not too oily or dry
Oily (Greasy or shiny)
Sensitive
Uneven (redness or bumps)
How does your skin normally react to the sun?
*
I always burn and don’t tan
I burn easily and tan poorly.
I usually burn and then get tan.
I burn a little and tan easily.
I rarely burn and tan dark easily.
I never burn and tan pretty dark.
Anything else that we should know?
How much downtime are you willing to tolerate?
*
None
A Little
Some
More Than Some
Quite A Bit
How did you hear about us?
*
Facebook
Instagram
Someone I follow on social media
Google or other search engine
Family or Friend
Yelp
Magazine Ad
Other
First Name
*
Last Name
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Mobile
*
Email
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SkillsInterests
For contour:
Dermal filler VirtueRF
For hydration:
Skinwave
For hyperpigmentation & melasma:
BBL Corrective Chemical Peels Halo Moxi
For scars & skin laxity:
VirtueRF Hyperdilute Radiesse Plasma Injections
For tone & texture:
Moxi CoolPeel Halo BBL Forever Young Chemical peels
For acne:
BBL Forever Clear Skinwave Chemical Peels
For Redness & Rosacea:
Laser Genesis Moxi Skinwave
For Sweat reduction :
Neuromodulators
For Dark circles under eyes:
PRFM injections Dermal filler
For Fat reduction:
Kybella or deoxycholic acid
For Unwanted hair:
BBL Forever Bare
For Volume Loss:
Dermal filler Biostimulators (Sculptra, Radiesse, PDO Threads) Plasma Injections
For Sun damage & Dark spots
BBL Corrective BBL Hero Moxi Halo
For lines & wrinkles:
Neuromodulator description Dermal Filler description VirtueRF Plasma Injections Halo
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