Galentines Event | B. Radiant Sign Ups
Event will take place at Mint Ivy Boutique | 116 E Main St. West Lafayette, OH
Please fill out the form to book your time slot at our event on Feb 4th! 
Sign in to Google to save your progress. Learn more
Email *
First & Last Name:  *
Phone Number: *
Email: *
Select the services you would like to receive at the event: *
Required
Botox & filler require a time slot. Other services such as teeth whitening or B12 can be done as walk-ins. If you chose Botox or filler above, please choose which time would be best for you: 
What is the best time for you? (Please keep in mind that we will give times based on a first-come first-serve basis but will follow up with you to give you the next available time if your choice isn't available:  *
ANY NOTES OR QUESTIONS? LEAVE THOSE HERE! :) 
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Paige Hough Photography. Report Abuse