Appointment Request

Home | home

Appointment Request

The

Harris Clinic

Your image. Our passion. TM

For a consultation without obligation.

North Shore, Baffin Island II, Lawren S. Harris

The Harris Clinic Appointment Request

Please let us know what kind of problem(s) you are experiencing for a consultation without obligation.

Your privacy is secure, and information is kept confidential.

Consultation Form

First and Last Name:

Contact Phone Number

Best Time to Contact

E-Mail Address:

Preferred Method of ContactVia EmailVia Phone

Message:

Preferred Appointment Day

Preferred Appointment TimeMorningsAfternoonsAny Time

Facial WrinklesClick Here

Tired, saggy looking eyesClick Here

Loose, saggy skinClick Here

My lips are thinClick Here

Excessive sweating in the armpits, palms, or soles of the feetClick Here

Embarrassing moles and unsightly skin tagsClick Here

Excessive hairClick Here

Embarrassing facial rednessClick Here

Brown patches, spots and sun damageClick Here

Liver spotsClick Here

FrecklesClick Here

Fine wrinkles on the face or chestClick Here

AcneClick Here

Acne scares (red or brown)Click Here

Rough or uneven skinClick Here

Enlarges pores, oily skin, blackheadsClick Here

Veins, spider veins, broken capillariesClick Here

hidden field

150 Brant Avenue

Brantford, Ontario. N3T3H7 CANADA

Tel: 519.720.0435 ~ Toll free: 866.520.0435 ~ Facsimile: 519.720.0435

www.harrisclinic.com

webmaster@harrisclinic.com