Northern Virginia's Radiance Fairfax Medspa
East Market at Fair Lakes
12585 Fair Lakes Circle Fairfax, VA 22033
703.222.0173

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New Client Forms

We are so glad you are coming! Please print and fill out the following forms and bring them with you on the day of your visit.

New Patient Medical History
Cosmetic Interest Questionnaire
Notice and Acknowledgement of Privacy Policy and Procedures


We would love to hear from you. If you have any questions, or want to learn more about our cosmetic specials, please give us a call or use the contact us form above on the left.
VISIT NORTHERN VIRGINA'S AFFORDABLE TOP RATED RADIANCE FAIRFAX MEDSPA!!
MAKE YOUR APPOINTMENT TODAY!!!

Bruce Freedman MD Radiance Fairfax Medical Director
Northern Virginia’s Radiance Fairfax Medspa
East Market at Fair Lakes
12585 Fair Lakes Circle Fairfax, VA 22033
703.222.0173
Copyright © 2013 Radiance Medspa Fairfax. All information is trademarked and copyrighted. All rights reserved.