You Could be the Next Fresh Face of Rochester! - Lifetime Health Medical Group

It's not too late to enter! Submit your entry today, and you could be our winner!

The chosen candidate will receive a free consultation with Dr. Brett Shulman, board-certified dermatologist at Lifetime Health. After your consultation, you will determine a timeline comfortable for you in which the cosmetic procedures will be administered. Once complete, you will also receive hair and makeup services from Beau Monde Salon & Spa to complete the makeover!

If you answered yes to two or more of the following questions, spring back to life and enter “Fresh Face of Rochester” Lifetime Health Medical Group makeover!

Do you think you look old for your age?

Have you ever thought about doing something to improve your appearance?

Do you want to reduce the look of aging without undergoing major surgery or needing recover time?

Are you unhappy with fine lines and wrinkles?

*Please do not include any personal health or confidential information in your submission.

All fields except photo are required.

Name:
Address:
City/Town of residence:
Phone number:
	Please enter phone as ###-###-####
Email:

Your actual age:
Age you think you look:

Have you ever visited a dermatologist or other provider for cosmetic procedures? If so, describe:
What skin-related problems would you like to try to improve? For example: wrinkles, frown lines, unwanted hair.
Tell us why you should win the makeover:

Please upload a recent picture of yourself:

By checking this box, you: Verify that you meet all of the "Medical Criteria and Requirements for Recipient" as listed below. Agree to share your makeover experience with the news media if selected as the recipient. Give Lifetime Health Medical Group and Rochester Healthy Living authorization to use your story and image in marketing and promotional materials, including but not limited to, our Web sites, advertising, newsletters and broadcast.

Medical Criteria and Requirements for Recipient

Recipient must be age 18 or older

Have never received laser, BOTOX^®, Juvéderm^TM or Radiesse^® services before

No medical contraindications to treatment with any of the medical products

No history of medical and/or psychological problems that would preclude treatment

Not pregnant or lactating

No history of HIV or Hepatitis B or C exposure, and willingness to be tested or be rejected for treatment if testing requested

Willingness and ability to provide informed consent for treatment

Willingness to allow photography and to utilize photographs for marketing purposes

Appropriate candidate for treatment with BOTOX^®, laser, injectable fillers such as Juvéderm^TM, Radiesse^® or chemical peeling

Willingness to talk with media if requested

No known allergy to the active agent or constituents of the carrier vehicle

Individuals covered by government-sponsored health plans, including Medicaid and Medicare are not eligible to participate

Employees of Lifetime Health Medical Group, or its affiliates, employees of Rochester Healthy Living and employees of contest sponsors are not eligible to participate