Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. else? dashes) areas Request a Botox Quote Transparent Flat-Rate Pricing (If you are ready to book your consult and want to use our online scheduler (Click Here) Have you visited us before? *I am a new patient.I've been there before.What areas do you want to treat with Botox? (check all that apply)Between the eyebrows (glabella)ForeheadAround the eyes (crow's feet)Neck Bands (platysma)Masseter (TMJ)Trapezius (Trap Tox)Hyperhidrosis (sweating)Gummy SmileLip FilpOtherName *FirstLastEmail *Preferred Telephone Number (no dashes)Can we help you with anything else? ** By filling out this form you agree to get email, text, and phone communications from The Dermatology and Laser Group.Submit