Virtual assessments

Request Information

Name

First Name

Last Name

Phone

(###)

###

####

Email Address

Questions

Request Consultation

Name

First Name

Last Name

Phone

(###)

###

####

Email Address

Questions/Comments

We are now offering virtual assessments

As the world responds to COVID-19, we hope you're keeping well and taking care during this time of uncertainty. We are continuing to adapt to the new challenges facing our services and will continue to keep all of our clients up to date.

Please Fill out the following form to set up your Virtual Aesthetic Consultation.

Virtual Assessment Form:

Virtual Assessment

Name

First Name

Last Name

Phone

(###)

###

####

Please check box below, if a message can be left. at this number.

Voicemail

Text message

Date of Birth

Address

Street Address City Province

What Service Are You Interested In

What Are Your Aesthetic Goals?

Please provide a brief description of your aesthetic goals, what you want to enhance about your features and what bothers you the most about your aesthetic appearance. *

How Did You Hear About SkinDiva Injection Artistry?

I have read the following information, and give my consent to this visit being done either by phone call, zoom, facetime or email.

VIRTUAL CONSENT Just like online shopping or email, using Virtual Assessments may subject you to possible privacy or security risk that your health information may be intercepted or unintentionally disclosed. We want to make sure you understand this before we proceed. In order to improve privacy and confidentiality, you should also take steps to participate in this virtual care encounter in a private setting and should not use an employer’s or someone else’s computer/device as they may be able to access your information. You should also understand that this virtual assessment will allow Dr. Ferguson and I to create a treatment plan for discussion and that this is not a substitute for the initial physical consultation that will be discussed with Dr. Ferguson the medical director.

I Understand The Following Information

Consultations

Each client is required to have a consultation prior to receiving aesthetic injections so we can create a safe individualized treatment plan. These consultations consist of detailed medical history, assessment of contraindications, the discussion of benefits and risk factors. Consultations are complimentary and are great to discuss your aesthetic goal without having to make any commitments.