*1.Full name (each attendee must complete the form)(Required.)

*2.Phone Number(Required.)

*3.Email Address(Required.)

4.Please select the treatment(s) you are interested in.

Botox/Dysport - $11 per unit

Starformer Chair - $70 for 20 minute session
(Uses non-invasive, technology to selectively target muscle tissues and provide strengthening, toning and firming of the pelvic floor muscles, glutes, abdomen, hamstring area, arms, and back muscles)

VI Peel Treatment - $125
(A chemical peel designed to improve skin tone, texture, and clarity by exfoliating the outer layers of the skin and stimulating collagen production.Address various skin concerns, including acne, acne scarring, sun damage, fine lines, and wrinkles)

Consultation - No charge
(One of our nurse practitioners will meet with you to answer your questions, discuss your concerns, and suggest the most suitable treatment options)

MIC+ B12 Injection - $35
(A combination of Vitamin B12 and a mixture of three amino acids: Methionine, Inositol, and Choline (MIC). Supports weight loss, boosts energy, and improves overall metabolic function)

Not Interested in receiving treatment

5.When would you like to receive treatment?

August 17th - Day of the event (I understand that I MUST schedule a consultation prior to the day of the event in order to be treated)

Later date (MUST be treated before September 17th to receive discount; a Uwellness Medical staff member will contact you to schedule an appointment)

Not Interested in receiving treatment

6.Any other questions or concerns?