Botox IntakePlease open and attach the intake form below to the website form. This form will route to Vanish, Inc. and our in-house practitioner. Intake FormFirst Name *Last Name *Email Address *Phone Number *Additional notes0 / 180Attach Completed Intake Form *Choose FileNo file chosenDelete uploaded fileConsent *Yes, I have filled out my personal and medical information accurately and consent to your review of this intake information.Submit Form See Medical Supplements to Avoid