First Name *

Last Name *

Address, City, State, Zip *

Please start typing your address. We will try and find a match for you. You can select from the list if a matching address shows up or continue typing

Email *

Cell phone #: *

Please provide which wireless cell phone service you have so that we can set up a text reminder.

Date of Birth *

Which location is closest to you? *

How did you hear of us? *

Tell us a little about what service you might be interested in: *

Thank you! We'll be in touch shortly!!

Patient Photo: Please take a selfie or upload a recent photo for your patient records. It is strictly confidential.

$20 off your 1st Laser Procedure*

$20 off New Patient Voucher. Must be presented to receive promotion. Patients must visit Cosmetic Laser Solutions within 30 days of becoming a new patient to redeem this promotion. Cannot be used in combination with any other discount or promotion. Offer valid for laser treatments over $250.