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Bentley Fall Content Model Call🍁✨

Full Name

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Email Address

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Phone Number

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Have you been a patient/client at Bentley before?

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A

Yes

B

No

What treatments are you interested in?

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HydraFacial

Chemical Peel

Microneedling

IPL

Dermaplaning

Other esthetic treatment

CO₂ Laser

Erbium Laser

Other physician-performed treatment

I’m open to whatever treatment Bentley recommends

What are your primary skin concerns/goals?

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Hydration/dryness

Dullness

Texture

Fine lines/wrinkles

Pigmentation/sun damage

Acne/acne scarring

Redness

Overall skin rejuvenation

Other

Tell us a little more about your skin goals:

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Content Usage Consent

*

I agree that my content may be used on Bentley Skincare & Wellness social media, website, email marketing & advertising.

Additional Notes

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What days/times are you generally available?

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Weekday mornings

Weekday afternoons

Weekday evenings

Saturdays

Flexible

Please list any specific dates you’re available:

*