consultation request form

First Name

Last Name

Date of Birth

Phone #

How did you hear about Tamara Paramedical?

What is the area of concern?

Do you sunbathe or use tanning beds?

Yes

Do you have any allergies or known medical conditions?

Are you on any medication? (including Accutane within the last 6 months, vitamins or supplements)

Are you 18 years or older?

Yes

Is your treatment inquiry the result of a surgery?

Have you tried any alternative methods such as laser therapy or microneedling to treat your condition?

Thank you for your interest!

You will receive a response by email within 72 hours. Please be sure to check your junk mail folder.

Please note, that while online consultations are free, your case may require a $60 in-person consultation.

While it is non-refundable, the cost will be put towards your treatment should we proceed.