Request an Appointment

Appointment Location *

Are you a NEW patient? *

Yes, I am a NEW patient

No, I am an EXISTING patient

First Name *

Last Name *

Phone *

Email *

What service or treatment would you like? (Include specific areas) *

Anything else you would like to share?

Please provide 3 appointment dates & times that work for you:

Option 1
Option 2
Option 3

PLEASE NOTE: Your request is not complete without a final confirmation. You will be contacted by a Prolase representative to confirm your final appointment date and time.

I have read and acknowledge the Cancellation & No-Show Policy provided by Prolase. By providing my phone number, I agree to receive text messages from the business.

Disclaimer: Although we strive to accommodate your preferred appointment dates and time, we cannot make any guarantees due to a number of conditions, including, but not limited to: business hours of operation, staffing, equipment, availability, and holidays. Due to the high volume of calls, please allow us up to 48-hours to respond to your appointment request.