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Interested in getting a luxury facial?

Fill out the following information and a Patient Navigator will be in touch with you shortly to schedule your facial.

Request Facial
Health Declaration

Please fill out so we can give you the best facial experience. Appointments are in NYC courtesy of Biologique Recherché.

This is a perk. Thanks for being a monthly members who has signed up in our supportive care model.

For internal use only. We will never share your information.

First name

Last name

Email

Date of Dignosis

Have you had a diagnosis of cancer? *

No

Yes

Are you currently in treatment for cancer? *

No

Yes

Are you experiencing a different heath issue? *

No

Yes

If you answered yes to any question, please elaborate

Select any that apply to you:

Surgery

Lymphy Node Removal

Chemotherapy

Hormone Therapy

Radiation

Recurrence

Metastasis

None of the above

I declare that the info I’ve provided is accurate & complete

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You Can Thrive! (917) 463-4267 • A Collective of Talented Practitioners & Locations • Main Office: 535 W 23rd. St, NY, New York, NY

Text on this website intended for informational purposes and not intended to substitute for medical advice.

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