Same-day appointments may be available so please call our office if you want an appointment today. 

 

Please be aware that you are submitting a request only. A representative from our office will contact you within 24 to 48 business hours to confirm a date and time. If this is a medical emergency, please do not fill out this form, call 911.

 
 
 
Request a Consultation
First Name:    Last Name
  
Date of Birth:
Daytime Phone:    Cell Phone:
  
Email:    Confirm Email:
  
Address:
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Best way of reaching you:    Type of Patient:    Type of Appointment:
  
  
  
  
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If other, please specify:    Who may we thank for referring you?
  
Preferred day (Check all that apply)    Preferred Time:
     
     
  
     
   
NewTrend Medical Spa 270 Center Dr., Suite #200, Vernon Hills, IL 60061 (847) 242-1737
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