gtr (c) Apycom Free Brochure . How May We Help You? .*These fields are required. All information is kept strictly confidential. *First name *Last name ..*Address Apt. # ..*City *State *Zip Sex: Please Select Male Female .Age (Optional): ..* How May We Contact You?: Please Choose One E-mail U.S. Mail Day Phone Evening Phone Cell Phone Day Phone Evening Phone Cell Phone E-Mail Address * Please send me your free color brochure. I would like to schedule a free consultation to evaluate my hair loss options. I would like to schedule a free consultation for laser hair removal. I would like to schedule a free consultation for 1 - hour teeth whitening. I would like to schedule a free consultation to evaluate my facial & skin restoration. options. I would like to schedule a free consultation for laser vein removal. I would like to schedule a free consultation to evaluate my permanent cosmetics options. Please Tell Us Which Form Of Hair Loss You Are Experiencing: Pattern Baldness Alopicia Chemo Not Sure I would like to schedule a free consultation for laser removal of shaving bumps. Please Tell Us Which Service You Are Interested In: Hair Restoration .....Skin Rejuvination .....Permanent Cosmetics .....Skin Restoration ......Laser Hair Removal......Laser Vein Removal.....Laser Removal of Shaving Bumps.....1 - Hour Teeth Whitening What day of the week would you like to visit us?Mon TueWedThurFriSat What part of the day is best for you? morning afternoon evening Are you currently using any type of hair loss product, service, medication? No Yes Are you currently using any type of skin care product, service, medication? No Yes How did you hear about A&E NYS Surgery Center? Newspaper Yellow Pages Radio Television Referral Web/Search Engine *These fields are required Any Questions? Please submit them in the text box, below. We will be pleased to answer them within 24 hours: HAIR REPLACEMENT, SKIN REJUVENATION & TEETH WHITENING CENTER 5781 Bridge St. Chimneys Plaza Suite #38 Syracuse, NY 13057 (Ph)1- 888 - 811- 4247 (Fax) 315 - 445 - 9217 E-Mail: info@aenys.com Hours Monday: 9am To 8pm Tuesday: 9am To 8pm Wednesday: 9am To 8pm Thursday: 9am To 8pm Friday: 9am To 5pm Saturday: 9am To 1pm Member Member Better Business Bureau of Central New York © 2004-2007 A & E and NYS Surgery Center
(c) Apycom
Free Brochure .
How May We Help You?
How did you hear about A&E NYS Surgery Center?
Any Questions? Please submit them in the text box, below. We will be pleased to answer them within 24 hours:
HAIR REPLACEMENT, SKIN REJUVENATION & TEETH WHITENING CENTER
5781 Bridge St.
Chimneys Plaza Suite #38
Syracuse, NY 13057
(Ph)1- 888 - 811- 4247
(Fax) 315 - 445 - 9217
E-Mail: info@aenys.com
Hours
Monday: 9am To 8pm
Tuesday: 9am To 8pm
Wednesday: 9am To 8pm
Thursday: 9am To 8pm
Friday: 9am To 5pm
Saturday: 9am To 1pm
Member
Better Business Bureau of Central New York