Request a Consultation

All requests for consultations will be contacted by phone/email during business hours Tuesday – Saturday.  Please indicate if you are available for a consultation during the day, early evening or Saturday.

Burlington Medi Spa will be closed on Saturday, May 18 – Wednesday, May 22.  I will  return any emails or calls on May 23.

* First Name:

* Last Name:

Address:

City:

Province:

Postal Code:

Home Phone:

Cell Phone:

Business Phone:

* Email:

* Best Time to Call:

* Age:

* Concerned About:

* When would you like to have a consultation:

* How would you like me to contact you?

Please enter the characters above: