Thank you for your interest in participating in our Botox - Filler Training and helping to train our excellent surgeons become even better.  Please fill out this survey to get registered.

If you wish to receive Botox and Filler, there are only a few slots.  Out of respect to our other patients and surgeons, there will be limited capacity to add treatments the day of the training. 

Address:
Kentucky Clinic
UK Ear Nose & Throat Clinic
3rd Floor
740 South Limestone St
Lexington, Kentucky 40536

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* 1. Your contact info:

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* 2. Please provide your Facebook and/or Instagram name

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* 3. What treatment(s) would you like to receive?

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* 4. What areas would you like treated with Botox?

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* 5. What areas would you like treated with Filler

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* 6. Have you previously received botox treatment

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* 7. Have you previously received filler treatment? 

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* 8. When was your last Botox treatment (if you're able, please obtain treatment details: 1. # of units per area 2. A treatment map if available)

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