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Medical Dermatology
Medical & Surgical Dermatology
Mohs Surgery
Medical Aesthetics
Medical Aesthetics
Specials & Referral Program
Forever Young BBL
Neuromodulators
Dermal Fillers
Sculptra®
HALO™ Laser
CoolSculpting® Elite
PDO Lifting Threads
SkinPen Microneedling
HydraFacial™
Optima Research
Optima Research
Current & Recruiting Dermatology Studies
About Us
Why Optima
Physicians & Providers
Careers
Blog
Contact Us
Request Appointment
Covid-19 Protocols
Find a Location
Book Appointment
Patient Portal
Physician Referral
Bill Pay
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Thank you for taking the time to fill out the cosmetic questionnaire! Your entries allow us to provide the best service for all your skin care needs. Please enter your name and email address and click Next to proceed.
Select a Location
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Bedford, NH - Optima Dermatology & Medical Aesthetics
Salem, NH - Optima Dermatology & Medical Aesthetics
Scarborough, ME - Optima Dermatology & Medical Aesthetics
Stratham, NH - Optima Dermatology & Medical Aesthetics
Macedonia, OH - Optima Dermatology & Medical Aesthetics
Mentor, OH - Optima Dermatology & Medical Aesthetics
Greenwood, IN - The Dermatology Center of Indiana
Plainfield, IN - The Dermatology Center of Indiana
Zionsville, IN - The Dermatology Center of Indiana
Name
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Please select any areas of concern. Check all that apply.
Please select any areas of concern. Check all that apply.
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Forehead Lines
Neck Wrinkles
Skin Appearance & Texture
Frown Lines
Lip Appearance & Texture
Acne Scarring
Crow’s Feet Lines
Thin Lips
Redness
Flat Cheeks
Lines & Wrinkles Around The Nose & Mouth
Brown Spots / Age Spots / Sun Damage
Other Areas of Concern
Products and Treatments
What products or services would you like to learn more about?
Injectables - Neuromodulators
Botox®
Dysport®
Daxxify®
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Injectables - Neuromodulators
Botox®
Dysport®
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Injectables - Dermal Filler
Restylane®
JUVÉDERM®
RHA® Collection
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Injectables - Dermal Filler
Restylane®
JUVÉDERM®
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Additional Injectables
Sculptra®
Kybella®
Additional Injectables
Sculptra®
Microneedling
SkinPen®
INTRAcel™ RF (Radio Frequency)
Microneedling
SkinPen®
Laser & Light Treatments
HALO® Hybrid Fractional Laser
Forever Young BBL™ (BroadBand Light)
Forever Clear® BBL™
Forever Bare BBL™ (Laser Hair Removal)
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Laser & Light Treatments
Fraxel® Laser
Vbeam® Laser
Forever Young BBL™ (BroadBand Light)
Forever Clear® BBL™
Laser Hair Removal
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Other Facial Treatments
Hydrafacial®
Visia® Skin Analysis
Dermaplaning
Chemical Peels
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Other Facial Treatments
DiamondGlow®
OxyGeneo
Visia® Skin Analysis
Dermaplaning
Signature Facial
Chemical Peels
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