Appointment Request

The first step towards a beautiful, healthy look is to schedule an appointment. If you would like to request an appointment with Dr. Hardy, please feel free to call 1-888-800-0118 during normal business hours to speak directly with our scheduling coordinator, or if you prefer, please fill out the online request form below and we will accommodate your request to the best of our ability.

NOTE: Please check your phone number for accuracy. Our scheduling coordinator will contact you to confirm your appointment time, or reschedule if there is a conflict. Please do not use this form to cancel or change an existing appointment.

*Required.

Name:*
Email:*
Phone:*
Address:
City:
State/Province:
Zip/Postal:
Desired Appointment Date:
Desired Appointment Time:	Select One Early Morning Late Morning Early Afternoon Late Afternoon Evening
What is Your Primary Interest:	Select One Facial Appearance Breast Appearance Body Appearance Facials Massages Post-Op Check-Up Other

Are you a current patient?
Yes No

Best time(s) to call?
Morning Noon Afternoon Evening

Questions or Comments concerning appointment:

Saturday appointments are based on availability and are by appointment only.

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.