3560, Delaware street, Suite 107. Beaumont, TX 77706
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Chrome Laser Treatment for Face & Neck
Scarlet SRF Facial Treatment
VI Peel Chemical Peel
The Miami Peel®
ViVi Nonsurgical Facelift
PDO Thread Lift
Wrinkles & Sagging Skin Treatments
Subnovii Plasma Pen
Exosomes Facial Rejuvenation
Acne Scar Reduction
Microneedling Collagen Induction Therapy
Laser and IPL Facial
Chin Augmentation with Fillers
Laser Teeth Whitening
Scarlet SRF Body Treatment
BeautiFill Laser assisted liposuction and fat transfer
Cellulite, Fat Reduction & Contouring
Laser Hair Removal
Stretch Marks Reduction
Toenail Fungus Laser Treatment
Glutathione Skin Lightening
Laser Vein Reduction Therapy
Alma TED Hair Restoration
Exosomes Hair Restoration
PRP Hair Regrowth & Restoration
Ideal Protein Weight Loss Clinic
MIC Lipotropic Injections
Free Hormone Wellness Quiz for Women
Free Hormone Wellness Quiz for Men
Women’s Intimate Health Female Intimate Health
Men’s Intimate Health
News & Specials
Please answer all questions listed below. Once completed, please send back to
and attach a current picture of yourself to email.
What is your height?
What is your current weight?
What is your current dress size?
What is your current jean size?
What are your areas of concern and chief complaint?
What are your expectations?
Are you interested in having a fat transfer? If so, what areas would you like to have transferred to?
Do you have any underlying health conditions? Yes or No
Please list below if you answered yes.
Are you currently taking any blood thinners and or for life? Yes or No
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If yes, Please list
Thank you kindly,
Revivify Medical Spa!