Request a Consultation

Request your skincare consultation to discuss your skin concerns and goals. Burlington Medi Spa is open Tuesday – Saturday by APPOINTMENT only.  Please don’t wear any perfume to your appointment as this is a scent free office.

* First Name:

* Last Name:

Address:

City:

Province:

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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?

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