Consultation Request

If you are considering cosmetic surgery we suggest a private consultation with Dr. Ala Lozinski to have your questions answered fully. To book an appt. please complete the form below.

Required fields are marked with *

Name:*
Mailing Address:*
City:*
Province:*
Postal Code:*
Home Telephone:
Business Phone:
Other Phone:
E-Mail:


Please tell us which procedure you wish to discuss during your consultation:

Tumescent Liposuction
Laser Neck Lift
Laser Wrinkle Removal
botox®: Frown Lines + Brow Lift
Chemical Peels
Collagen Restylane Artecoll		 IPL Photorejuvenation
Laser Treatment Facial Veins
Leg Vein Treatment
Other Skin Surgery
Non Sugical Rejuvenation
Thermage


Please tell us how you want us to contact you to arrange your consultation and
ensure that the appropriate phone number is provided:

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- Tumescent Liposuction - Neck Lift - T-Lift - Laser Eye Lift - Botox® - Restylane & Juvederm - IPL Photo-Rejuvenation - Vasculight - Laser Hair Removal - Laser Wrinkle Removal - Chemical Peels - Leg Vein Treatment - Thermage - Non-Surgical Rejuvenation -

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