RE-Wellness & IV Bar Model Call 04/25/26

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Model Call Questionnaire

1. Full Name *

2. Email Address *

3. Have you had neuromodulator treatments before?

Yes

If yes Which product(s) and when was your last treatment?

Other:

Clear selection

4. What areas are you interested in treating?

Forehead

Frown lines (11s)

Crow’s feet

Bunny lines

Lip flip

Other: ________________________________________________________________

5. Are you currently pregnant, breastfeeding, or planning pregnancy?

Yes

Clear selection

6. Do you have any neurological conditions or known allergies to botulinum toxin products?

Yes

Clear selection

7. Are you available on April 25 between 12 PM – 4 PM?

Yes

Clear selection

8. Are you comfortable being photographed for before & after images?

Yes

Clear selection

9. What is your primary goal or desired outcome?

Selected participants will be required to submit a $50 non-refundable reservation fee to secure their appointment.
This fee will be applied toward treatment on the day of service.

Appointments are confirmed on a first-come, first-served basis once the reservation is received.Untitled Title

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