Seattle Botox - Naficy Rejuvenation Center in Bellevue & Seattle

Our Facility

Botox FAQ

Botox Treatments

Youth Injections

Announcement

SEATTLE'S #1 BOTOX PROVIDER!

Naficy Plastic Surgery & Rejuvenation Center is proud to be the #1 provider of Botox Cosmetic in Seattle and Bellevue. Our clinic has 5 experienced Botox providers with a combined experience of over 50 years.

Announcement

Naficy Plastic Surgery & Rejuvenation Center receives prestigious membership into Allergan's National Education Faculty for Botox injections

Allergan's National Education Faculty (NEF) is a prestigious society of Botox providers who have been certified by Allergan not only in administering Botox treatments, but specifically certified by Allergan to train other physicians in the administration of Botox Cosmetic. The Naficy Rejuvenation Center's membership in the NEF assures you the highest level of skill and expertise in the administration of Botox injections by all members of our highly trained staff. We are in the top 1% of clinics nationwide for Botox injections and have been serving the Seattle and Bellevue area for 10 years.

Announcement

Look 10 years younger with just BOTOX & YOUTH INJECTIONS!

Naficy Plastic Surgery & Rejuvenation Center is offering our patients a quick and non-surgical alternative to a face lift. Using an innovative combination of Botox and volumizing Youth Injections in just 10-15 minutes we can take 10 years off your face - without any surgery and with minimal down-time!

Announcement

THE NON-SURGICAL FACE AND BODY LIFT!

As seen on Oprah, Thermage uses a patented radiofrequency energy for the treatment of facial and body skin laxity. Body Thermage treatments can tighten loose skin of the arms, tummy, chest, breasts, thighs, and even hands Face Thermage treatments can tighten loose skin of the entire face and neck, including the eyelid and eyebrows. Thermage treatments require NO DOWNTIME!

Announcement

SCULPTRA , the liquid face lift!

Seattle, WA - Sculptra, an FDA-approved injectable treatment for the face, is the newest and most exciting non-surgical way to give your face a lift without any plastic surgery or down-time. Results can last more than 2 years.

Patient Registration

On your first visit, you will need to complete a registration form and a medical history form. For your convenience, you may provide this information by filling out the online version of these forms below. Your information will be emailed to us at our office.

Last Name:

First Name:

Middle Initial:

Mr. Mrs. Miss Ms. Dr.

Date of Birth (mm/dd/yyyy) :

Address:

Street Address
City, State, Zip

Home Phone:

Work Phone:

Cell Phone:

Email:

Patient's Employer:

Patient's Occupation:

Marital Status:
Single Married
Widowed Separated Divorced

Spouse's Name:

Spouse's Employer:

Spouse's Occupation:

Person Responsible for Bill - Insurance Guarantor

Patient's relationship to person responsible for bill:
Self (skip to next section)
Spouse
Child
Dependent

Last Name:

First Name:

Middle Initial:

Address:

Street Address
City, State, Zip

Home Phone:

Work Phone:

Insurance Information

Primary Insurance:

Secondary Insurance:

Emergency Information and Release

In case of an emergency, local friend or relative to be notified
(not living at same address):

Name:

Relationship to Patient:

Home Phone:

Work Phone:

May we contact you to remind you about upcoming or missed appointments?
Yes No

Please provide your preferred contact phone number or email

Would you like to be excluded from mailings and email promotions?
Yes No

If you have any specific cosmetic interests, please check all that may apply:

Surgical:	Non-Surgical:
Rhinoplasty	Botox
Revision Rhinoplasty	Dermatology
Face Lift	Restylane
Mini Face lift	Sculptra
Neck Lift	Radiesse
Mini Neck Lift	Juvederm
Neck Liposuction	Perlane
Nose Reshaping	Artefill
Brow Lift	Fotofacial
Eyelid Lift	Intensive Fotofacial
Cheek Lift	Polaris for Wrinkles & Tightening
Chin Implant	Thermage for Face
Cheek Implant	Thermage for Body
Feather Lift	Thermage for Cellulite
Laser Resurfacing	Treatment of Age Spots/Freckles
Fat Injection	Laser Vein Removal
Lip Augmentation	Laser Hair Removal
Ear Reshaping	Sclerotherapy
Buccal Fat Removal	ToneAbrasion
Skin Cancer	Microdermabrasion
Scar Revision	Retinoic and Glycolic Peel

Please answer the following questions on a scale of 1 to 5:

When looking at my face in the mirror, I believe I look younger, the same as, or older than my true age.

Younger Than		True age		Older Than
1	2	3	4	5

When looking at my face in the mirror, the appearance of my face makes me:

Not Concerned		Somewhat Concerned		Very Concerned
1	2	3	4	5

I am looking for a procedure that can give me a:

Small improvement with minimal down-time		Moderate improvement with some down-time		Significant improvement with longer down-time
1	2	3	4	5

How did you hear about us?
(Check all that apply)

My physician
          (full name)
The yellow pages/telephone book
A friend or family member
          (name)
          May we contact him/her?   Yes    No
          Phone or Email:
Seattle Magazine's TOP DOCTORS
Internet search
          (Google, Yahoo, Other)
Online referral network
          (facialplasticsurgery.net, Other)

Newsletter or mailer
An article or advertisement in

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