Skip to main content
Aesthetic Clinic and Medical Spa DC
GLOWING SKIN RENEWAL.
BOTOX CLINIC WASHINGTON DC
COSMELAN MD® Treatment
CUSTOM CHEMICAL PEELS DC
INTIMATE AREA SKIN LIGHTENING
LASER HAIR REMOVAL WASHINGTON DC
Types of Laser Hair Removal
LASER SKIN RESURFACING
BLUE LED THERAPY
RED LED THERAPY
PRP HAIR INJECTION
RF Skin Tightening
HIFU Skin Tightening
FAT BURNING INJECTIONS
New Patient Forms
Enter Our Raffle
Acne Program Gallery
Dermal Infusion gallery
Lightwave LED Gallery
Laser Hair Removal gallery
PRP Hair Restoration Gallery
RF-IPL Photofacial Gallery
SkinPen Microneedling Gallery
Tattoo Removal Gallery
Vi Peel Gallery
Make An Appointment
Appointment for Acne Treatment Program
Appointment for Chemical Peel
Appointment for Dermal Filler Injection
Appointment for Hair Restoration
Book an appointment for Botox
Book an Appointment for Skin Tightening or Body Sculpting
Book an Appointment For Tattoo Removal
Book Appointment for Fat Injection
Book Appointment For RF-IPL Photofacial
Book Dermal Infusion
Book Dermaplaning appointment
Book Laser Hair Removal
Book Laser Resurfacing
Book Skin Microneedling
Botox and Fillers
Cosmetic Skin Treatments
Hair and Scalp
Laser Hair Removal
Medical Grade Skincare
Acne Treatment Products
Anti-Aging Skincare Products
Aesthetic Home Treatments Kits
Shipping and Return Policy
New Patient Forms
Medical Intake Form
How did you hear about us?*:
Check all Medical Conditions:
High Blood Pressure
Ulcers or Bleeding
Hepatitis B or C
Drug or Alcohol Addiction
Any other serious illness or injury:
Please list all current medications you are taking, and/or you have used in the past 6 months including: Birth Control, Aspirin or ibuprofen, Weight loss medication, Coumadin, or any blood thinning medication, prescription eye drops, steroids, or antibiotics:
Check all Skin Conditions
Melanoma or Skin Cancer
Check all topical medications
List all surgeries you have had (including plastic surgery):
Check Box for YES response:
Have you ever seen a Dermatologist for your skin Reason?
Are you pregnant or lactating? How many months
Have you ever taken Accutane? When?
Do you have a history of Herpes Simplex (cold sores)? Last Outbreak?
Do you have a history of developing Keloids (raised scars)
Do you have irregular periods? Explain:
Do you smoke cigarettes or use tobacco products? How often?
Do you use recreational drugs? How often?
Do you drink alcohol? How often?
Have you ever been diagnosed with cancer? What kind and when?
What vitamins or supplements are you currently taking?
List all current skin care products
I am aware of the 48 hour cancellation policy. There will be a $50 charge for any treatment or consultation not cancelled at least 48 hours in advance. A full consultation fee or partial procedure fee of $125 will be charged for cancellation less than 24 hours.
Photographs are part of a detailed skin analysis. I consent to the taking of clinical photography and its use for controlled purposes in publications, presentations and marketing promotions. I fully understand that my identity will be protected.
Medical Grade Skincare Customized By Physicians Just For You!