Grey Aesthetics' Intro to Dermal Filler & Tox Immersive Hands-On Training Application Form

"*" indicates required fields

Date of Application*

Medical License #*

Training Course*

Dermal Filler & Neuromodulators

Tox Day Only

Filler Day Only

Personal Information

Name*

First Last

Nationality*

Address*

Street Address City State ZIP

Phone*

Email*

Date of Birth*

Please describe previous medical experience:*

Please describe any previous experience you already have with injectables, lasers, trilift, or peptides:*

Please list your top 3 goals for what you'd like to learn during this course and your goals for once you are certified:*

Each student can do a $200 add on to be a model. It will be $200 per syringe to be a filler model and/or $200 to get units of tox. This product will be injected by students in your class alongside the instructor. If you'd like to be a model, please list the areas you are willing to be a model for (ie. lip filler, cheek filler, forehead tox, etc.):*

This will be a full day 10:30 a.m. - 6 p.m. hands on course. Once your application has been submitted and you have been approved, we will send you a detailed itinerary and instructions for your training.

Course Deposit - A $500 deposit is required to secure your place in the course.

Payment Methods:

Credit Card
Bank Transfer
Check
Click here to see our Payment Plans / Financing Options

By submitting this application, you agree to pay the $500 deposit and understand that it is non-refeundable unless the course is cancelled by the organizer.*

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Application Form

Grey Aesthetics' Intro to Dermal Filler & Tox Immersive Hands-On Training Application Form

Personal Information

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