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Request an Appointment

Thank you for your interest in Masri Clinic for Laser and Cosmetic Surgery! Please answer the following questions to let us know what times are good for you.

Schedule an appointment online:

If you'd like to schedule an appointment at any time of the day, please use our online system below for requesting appointments.

Date:	Date: Enter date as MM-DD-YY
Time:	Time:
Location:	Location: Dearborn Birmingham
First Name: *	First Name: *
Last Name: *	Last Name: *
Phone Number:*	Phone Number: * ex. XXX-XXX-XXXX
E-mail Address:*	E-mail Address: *
Address Line 1:	Address Line 1:
Address Line 2:	Address Line 2:
City:	City:
State:	State:
Zip Code:	Zip Code:
Type of Appointment:	Type of Appointment:
	To help us better anticipate your needs, please tell us your reason for this appointment request.
Reason for Appointment:	Reason for Appointment:
Notes:	Notes:

	Click one option below to indicate the general time frame for your appointment.

Contact Date:

Request a free cosmetic consultation today!

Get $100 off your surgery by scheduling online!

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