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Regen Aesthetic Skin Laser Stem Cell Clinic Penang

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Help us understand your condition & treatment goal better by filling up these information & receive RM 50 treatment rebate

Last name

First name

Phone

Birthday

Day

Month

Year

Current Location

I am interested in

Improving my skin quality/acne/pigment

Improving my sagging face/body

Improving my knee joint pain

Hair Growth solution

Knee Joint Treatment

General Health Stem Cell Treatment

My Preferred Date for appointment is

I have done these treatments*

Facial

Laser

Face Injections

Thread

Knee Injections

I have never done any treatments

Surgery

Treatment Budget MYR*

below 1000

1000-5000

5000-10000

10000-15000

15000-20000

20k & above

Please let us know if you have any Medical illness, on any Medication/ Treatment and or if you have had previous Medicine / Treatment allergy or side effects.

Regen Clinic

regenklinik@gmail.com

+60109821931

REGENCLINIC SDN BHD 20151002008(1127340A)

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