Esthetic Institute Student Clinic

Student Clinic 703-288-4228 extension 104 
8381 Old Courthouse Road Suite 320 Floor Vienna, VA 22182

If you wish to request an appointment please fill out the form below. Our Clinic Technicians will contact you within 24-36 hours if during normal business hours, or the next open business day if you are contacting us after business hours or during Holidays. 

If the day and time you have requested is not availble, they will contact you by phone to go over availability. 

Please note that all services are performed by our Students under Licensed supervision. Appointments are based on student availability.

 

Last Name	*
First Name	*
Email Address	*
Confirm Email	*
Phone Number	*
Have you ever visited our Student Clinic before?	*	No Yes
If Yes what service did you receive?
What Service are you interested in?	*	Facials Chemical Peels Microdermabrasion Advanced Facials Hair Removal/Waxing Eyebrow / Lash tints Other (Give details in Comments) I want to be a Model for Nail Services. I want to be a Model for Permanent Cosmetic services.
Appointment Date	*
Appointment Time	*	Morning Afternoon
Please note that we can't guarantee the day or time you select, and we will contact you to confirm availability for that date or make suggestions for other available times. Our clinic availability is based on Student availability on the dates requested.
Comments / Instructions
For all Cancellation and Store Policies please visit: http://estheticinstitute.com/student-clinic
Security Code	*