Regenics
All fields are required
Type of Visit
B12 INJECTION
BOTOX
CRYO
LIPO STAT INJECTION
New B12 INJECTION
NEW BOTOX
NEW CRYO
NEW LIPO STAT INJECTION
PRP
AMINO BLEND INJECTION
NEW AMINO BLEND INJECTION
Video Visit
Office
Regenics
Reason for Visit
e.g. Initial Consultation
Patient name
Firstname Lastname
Date of birth
mm/dd/yyyy
Email
email@example.com
Home phone
(555) 555-5555
Cell phone
(555) 555-5555
Requested time
Select a time below under Available Times
You must select a date and time for your appointment.
Available Times
Previous Week
Next Week
Visit Length:
30 minutes
Submit Appointment Request
You will receive an email confirmation.
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Action Required: Confirm your appointment