360 Rose Ave,
Danville, CA 94526
925-838-4EMD (4363) 
promobook

VelaShapeTM is the only FDA cleared device that effectively and safely contours, shapes and slims the body by reducing cellulite and firming problem areas in as little as 4 treatments.

velashape2_logo

Latisse_Logo_purple
Health and Beauty with Dr. Sonia Consultation Request Form
Thank you watching Health and Beauty with Dr. Sonia! We hope you enjoyed the show and for your interest in Elite MD, Advanced Dermatology, Laser, and Plastic Surgery Institute. We are honored to be considered by you for your medical and aesthetic needs. As a Health and Beauty with Dr. Sonia viewer, you are entitled to a complimentary consultation! Please fill out the below form to qualify for our complimentary consultation with Dr. Sonia or Dr. Bansal. Please also feel free to contact us at 925-838-4EMD (4363) to schedule a personal consultation. Be sure to mention that you are a Health and Beauty viewer to qualify for a complimentary consultation.
Please provide the following information so we can better serve you. (*) Required Information
First Name (*)
Please provide your first name.
Last Name (*)
Please provide your last name.
Phone (*)
Invalid Input
Email (*)
Invalid email address.
City
Invalid Input
Which procedures / services are you interested in? (please check all that apply)  
  


















Invalid Input
Invalid Input
If you wish, please provide us some information on why you will be coming to our facility.
Invalid Input
I would like to receive email discounts and promotions. (*)
Invalid Input
Thank you for taking the time to fill out our form. We look forward to speaking with you and adding you to the Elite MD family. Thank you for considering Elite MD. For your privacy, this information will be used solely by Elite MD and will not be shared with any other persons or organizations.