Book an Appointment

Name:
Email Address:
Phone:
e.g. 647-123-4567
Is this your first appointment with Skin Med Laser Clinic?
Yes No
Preferred appointment times:
Doctor's hours are Monday, Wednesday, Friday 3-7pm and Tuesday, Thursday, Saturday 10-2pm.
Please provide several alternative dates.
1) Date:
Time:
2) Date:
Time:
3) Date:
Time:
Visit Reason(s):
Age Spots & Freckles
Wrinkles & Fine Lines
Acne & Acne Scar
Facial Capillaries
Rosacea (Facial Redness)
Excessive Sweating
Facial Contouring
Tattoo Removal
Laser Hair Removal
Pore Size Improving & Overall Toning
Sagging Skin
Scar Revision
Others, please specify :
Other Comments:

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