53 Fairfax Road, St Albans, VT 05478 802-528-2738

Patient Intake Form

Please fill out the form below

* Fields marked with an asterisk are required.
* Additionally, if you are a laser patient who has a pre-paid package on file with us and you fail to cancel an appointment within 24 hours or are a no call no show you will lose one pre-paid service in the package per missed appointment.

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