Please fill in the form below and we will contact you soon.
All information shared is completely confidential. Consultations are complimentary, however in order to better accommodate our guests we require a credit card number to reserve your appointment. Your credit card will not be charged at the time of booking.
Your Name
*
Your Phone
*
-
Area Code
Phone Number
Your Email
*
Date of Birth
*
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What are you interested in?
*
General Skin Care
Skin Resurfacing/Tightening
Laser Hair Reduction
Laser Tattoo Removal
Injectables
Bodysculpting
Botox® Cosmetic
diVa Treatment
Other
How did you learn about Rejuvené?
*
Physician
Internet Search
Friends or Family
Yellow Pages
Facebook / Instagram
Other
Best time to call you
*
8am-12pm
1pm-5pm
Preferred appointment time
*
Morning
Afternoon
Preferred appointment location
*
Chico
Yuba City
Oroville
Any concerns or comments?
Submit
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