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 Friday, February 14 – Monday, February 17.  I will  return any emails or calls on Tuesday, February 18.


* First Name:

* Last Name:




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?
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