Select Your City... Birmingham - The Summit Chandler Phoenix San Tan Village *Coming Soon* Scottsdale Tucson Village Prasada *Coming Soon* Antioch/Brentwood Burlingame Clovis Concord Corte Madera Dublin Emeryville Fremont Fresno Los Gatos Milpitas Mountain View Novato Oakland Palo Alto San Carlos San Francisco - Castro San Francisco - The Marina San Francisco - Union Square San Jose San Ramon Tracy Walnut Creek Corona Hills Rancho Cucamonga - Victoria Gardens Bakersfield Beverly Hills - Robertson Elinor at Hollyhill *Coming Soon* Glendale Hermosa Beach Long Beach Los Angeles - Downtown Marina Del Rey Oakbrook Plaza *Coming Soon* Oxnard Pacific Palisades *Coming Soon* Pasadena Porter Ranch Santa Monica Sherman Oaks Valencia West Hollywood Woodland Hills Anaheim Hills Brea Cerritos Costa Mesa Fullerton Metrocenter *NEW* Huntington Beach Lake Forest Mission Viejo Newport Beach - Crystal Cove Orange Tustin Arden Pavilions *NEW* Elk Grove Folsom Roseville Sacramento Carlsbad Chula Vista Escondido Hillcrest La Jolla - UTC La Mesa San Diego - 4S Ranch Temecula Reve Boulder *Coming Soon* Tennyson *Coming Soon* Belmar Denver - Cherry Creek Lone Tree - Park Meadows Stamford Coral Gables Fort Lauderdale Jacksonville Kendall Pembroke Pines South Beach St. Petersburg - Evo *Coming Soon* Tampa Heights Atlanta - Buckhead Atlanta - Midtown Honolulu Boise - Meridian Elmhurst Crossing *Coming Soon* Evanston Naperville Northbrook Bucktown Lincoln Park River North West Loop IND - Bottleworks *Coming Soon* Bradley Fair *Coming Soon* Kansas City North Bethesda Boston - Fenway Somerville Wellesley *NEW* Minneapolis - Edina STL-Central West End *Coming Soon* Henderson Las Vegas Summerlin Edgewater Englewood Hoboken River Front Center *Coming Soon* Albuquerque Meatpacking Park Slope Scarsdale Brooklyn Heights Williamsburg Garden City Manhasset *Coming Soon* Woodbury Flatiron Morningside Heights *NEW* TriBeCa Upper East Side Upper West Side Astoria Charlotte - South End Sutton Square *Coming Soon* Short North *Coming Soon* Oklahoma City Cedar Hills Crossing *Coming Soon* Portland - Tigard Ardmore West *Coming Soon* Philadelphia - Rittenhouse Nashville - Green Hills Austin - EastSide Austin - The Domain Arlington - TX Fort Worth Frisco Gates of Prosper *NEW* North Park Plaza at Rockwall *NEW* Southlake El Paso *Coming Soon* Friendswood - Baybrook Houston - Galleria Houston - The Woodlands Houston Heights Sugar Land Alamo Ranch *NEW* San Antonio Salt Lake City Salt Lake City - Murray Alexandria - Old Town Arlington - VA Ashburn Reston Tysons Kirkland Seattle - University Village DC - The Yards *Coming Soon* Washington DC Hilldale *Coming Soon*

{ "settings": { "useServiceHiddenField": false }, "steps": [ { "id": "services", "type": "button-selection", "question": "Which one are you interested in?", "dynamicTarget": true, "firstStep": true, "target": "form-name", "answers": [ { "text": "BOTOX & XEOMIN", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/botox-1.png", "value": "Botox", "target": "botox-services" }, { "text": "CLEAR & BRILLIANT", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/clearbrilliant.png", "value": "Clear + Brilliant", "target": "clear+brilliant-services" }, { "text": "COOLSCULPTING", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/coolsculpting-1.png", "value": "CoolSculpting", "target": "coolsculpting-services" }, { "text": "IPL PHOTOFACIALS", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/BottomNav-Light-IPL-1.png", "value": "IPL Photofacial", "target": "ipl-services" }, { "text": "DERMAL FILLERS", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/dermalfillers.png", "value": "Dermal Fillers", "target": "dermal-fillers-services" }, { "text": "LASER HAIR REMOVAL", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/laserhairremoval.png", "value": "Hair Removal", "target": "hair-removal-services" }, { "text": "SKIN REJUVENATION", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/laserskinrejuvenation.png", "value": "Skin Rejuvenation", "target": "skin-rejuvenation-services" }, { "text": "TATTOO REMOVAL", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/tattooremoval.png", "value": "Tattoo Removal", "target": "tattoo-services" }, { "text": "THERMAGE", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/thermage.png", "value": "Thermage", "target": "thermage-services" }, { "text": "HYDRAFACIAL", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2023/10/hyfrafacial-1-1.png", "value": "Hydrafacial", "target": "hydrafacial-services" }, { "text": "POTENZA RF MICRONEEDLING", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2023/12/RFmicroneedling.svg", "value": "RF Microneedling", "target": "potenza-rf-microneedling-services" } ] }, { "id": "botox-services", "type": "button-selection", "question": "What do you want to treat with Botox?", "target": "treatment-count", "canSelectMultiple": false, "answers": [ { "text": "CROW'S FEET", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/crowsfeet-severe.png", "value": "crows-feet" }, { "text": "FROWN LINES", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/frownlines-moderate.png", "value": "frown-lines" }, { "text": "PREVENTION", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/other.png", "value": "prevention" }, { "text": "FOREHEAD LINES", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_1_00000048492736188866793050000017805665106656178851_.png", "value": "forehead-lines" }, { "text": "FINE LINES & WRINKLES", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2023/09/bunnylines_tgr9ce.png", "value": "fine-lines-wrinkles-lines" }, { "text": "CHIN DIMPLES", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2023/09/chinupperlip-acne_1_p00x6j.png", "value": "chin-dimples" }, { "text": "LIP FLIP", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2021/08/fullerlips-1.png", "value": "lip-flip" }, { "text": "LIP LINES", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2021/08/definedlips-1.png", "value": "lip-lines" }, { "text": "NECK-BANDS", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2021/08/neck-1.png", "value": "neck-bands" } ] }, { "id": "clear+brilliant-services", "type": "button-selection", "question": "Why do you want Clear + Brilliant?", "canSelectMultiple": false, "target": "treatment-count", "answers": [ { "text": "ACNE SCARS", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_1.png", "value": "acne-scars" }, { "text": "AGE SPOTS", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/agespots.png", "value": "age-spots" }, { "text": "DULLNESS", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_1_00000023275290920588681870000015240469521700868541_.png", "value": "dullness" }, { "text": "FINE LINES", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/ReplenishLostVolume.png", "value": "fine-lines" }, { "text": "HYPERPIGMENTATION", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_1_00000031200112466972895190000009647119818480900755_.png", "value": "hyperpigmentation" }, { "text": "MELASMA", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_1_00000058556429863106026800000016594759179205353877_.png", "value": "melasma" }, { "text": "PORES", "icon": "https://storage.googleapis.com/laseraway-dev.appspot.com/2021/08/c187f1f4-pores.svg", "value": "pores" }, { "text": "SUN DAMAGE", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_1_00000166671424757127320120000014177169169813912715_.png", "value": "sun-damage" }, { "text": "TEXTURE", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_1_00000096766009607905930770000004577942716063408298_.png", "value": "texture" } ] }, { "id": "coolsculpting-services", "type": "button-selection", "question": "Where would you like CoolSculpting?", "canSelectMultiple": false, "target": "treatment-count", "answers": [ { "text": "BACK", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/back-4.png", "value": "back" }, { "text": "BELLOW BUTT", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/other-butt.png", "value": "bellow-butt" }, { "text": "INNER THIGH", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/innerthigh.png", "value": "inner-thigh" }, { "text": "LOVE HANDLES", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_3-1.png", "value": "love-handles" }, { "text": "OUTER THIGH", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/outterthigh.png", "value": "outer-thigh" }, { "text": "ABDOMEN", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_3.png", "value": "abdomen" }, { "text": "UNDER CHIN", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/neck.png", "value": "under-chin" }, { "text": "UPPER ARM", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/upperarms-3.png", "value": "upper-arm" } ] }, { "id": "ipl-services", "type": "button-selection", "question": "What would you like to address?", "canSelectMultiple": false, "target": "treatment-count", "answers": [ { "text": "AGE SPOTS", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/agespots.png", "value": "AGE-SPOTS" }, { "text": "BROKEN CAPILLARIES", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_1_00000153694541318718417730000004868358805772514723_.png", "value": "BROKEN-CAPILLARIES" }, { "text": "COLLAGEN LEVEL", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_1.png", "value": "COLLAGEN-LEVEL" }, { "text": "FINE LINES", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/ReplenishLostVolume-1.png", "value": "FINE-LINES" }, { "text": "HYPERPIGMENTATION", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_1_00000031200112466972895190000009647119818480900755_-1.png", "value": "HYPERPIGMENTATION" }, { "text": "MELASMA", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_1_00000058556429863106026800000016594759179205353877_-1.png", "value": "MELASMA" }, { "text": "PORES", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_1_00000044885345945937442190000000246289599014143411_-1.png", "value": "PORES" }, { "text": "SUN DAMAGE", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_1_00000147217862669713079450000014903675268305941659_.png", "value": "SUN-DAMAGE" }, { "text": "ROSACEA", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_1_00000166671424757127320120000014177169169813912715_-1.png", "value": "ROSACEA" } ] }, { "id": "dermal-fillers-services", "type": "button-selection", "question": "Where do you want dermal fillers?", "canSelectMultiple": false, "target": "treatment-count", "answers": [ { "text": "CHEEKS", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/chinupperlip.png", "value": "CHEEKS" }, { "text": "LIPS", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/poutylip.png", "value": "LIPS" }, { "text": "MARIONETTE LINES", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/marionette.png", "value": "MARIONETTE-LINES" }, { "text": "SMILE LINES", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/laughlines.png", "value": "SMILE-LINES" }, { "text": "NASOLABIAL FOLDS", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/nasolabial.png", "value": "NASOLABIAL-FOLDS" }, { "text": "OTHER", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/ReplenishLostVolume-2.png", "value": "OTHER" } ] }, { "id": "hair-removal-services", "type": "button-selection", "question": "Which areas need hair removal?", "canSelectMultiple": false, "target": "treatment-count", "answers": [ { "text": "BACK", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/icon-back.png", "value": "BACK" }, { "text": "BIKINI", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/icon-bikini.png", "value": "BIKINI" }, { "text": "BRAZILIAN", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/icon-brazilian.png", "value": "BRAZILIAN" }, { "text": "CHEST", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/icon-chest.png", "value": "CHEST" }, { "text": "CHIN / LIPS", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/icon-lips.png", "value": "CHIN-/ LIPS" }, { "text": "FACE", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/icon-face.png", "value": "FACE" }, { "text": "LEGS", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/icon-legs.png", "value": "LEGS" }, { "text": "OTHER", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/icon-other.png", "value": "OTHER" }, { "text": "UNDERARMS", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/icon-underarms.png", "value": "UNDERARMS" } ] }, { "id": "skin-rejuvenation-services", "type": "button-selection", "question": "What would you like to address?", "canSelectMultiple": false, "target": "treatment-count", "answers": [ { "text": "ACNE SCARS", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/agespots-2.png", "value": "ACNE-SCARS" }, { "text": "AGE SPOTS", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_1-1.png", "value": "AGE-SPOTS" }, { "text": "COLLAGEN LEVEL", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_1_00000153694541318718417730000004868358805772514723_.png", "value": "COLLAGEN-LEVEL" }, { "text": "DULLNESS", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_1_00000023275290920588681870000015240469521700868541_-1.png", "value": "DULLNESS" }, { "text": "FINE LINES", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/ReplenishLostVolume-3.png", "value": "FINE-LINES" }, { "text": "HYPERPIGMENTATION", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_1_00000031200112466972895190000009647119818480900755_-2.png", "value": "HYPERPIGMENTATION" }, { "text": "MELASMA", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_1_00000058556429863106026800000016594759179205353877_-2.png", "value": "MELASMA" }, { "text": "PORES", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_1_00000044885345945937442190000000246289599014143411_-2.png", "value": "PORES" }, { "text": "SUN DAMAGE", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_1_00000166671424757127320120000014177169169813912715_-2.png", "value": "SUN-DAMAGE" }, { "text": "TEXTURE", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_1_00000096766009607905930770000004577942716063408298_-1.png", "value": "TEXTURE" } ] }, { "id": "tattoo-services", "type": "button-selection", "question": "Where are your tattoos located?", "canSelectMultiple": false, "target": "treatment-count", "answers": [ { "text": "ARM", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/arms.png", "value": "arm" }, { "text": "BACK", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/back-2.png", "value": "back" }, { "text": "CHEST", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/chest.png", "value": "chest" }, { "text": "FOOT", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/feet-1.png", "value": "foot" }, { "text": "HAND", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/other-hand.png", "value": "hand" }, { "text": "LEG", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/legs.png", "value": "leg" }, { "text": "NECK", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/neck.png", "value": "neck" }, { "text": "OTHER", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/other-butt-1.png", "value": "other" } ] }, { "id": "thermage-services", "type": "button-selection", "question": "Which area(s) would you like to target?", "canSelectMultiple": false, "target": "treatment-count", "answers": [ { "text": "ARMS", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/arms.png", "value": "ARMS" }, { "text": "CHEST", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/chest.png", "value": "chest" }, { "text": "FACE", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_1_00000023275290920588681870000015240469521700868541_-2.png", "value": "face" }, { "text": "HANDS", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/other-hand.png", "value": "hands" }, { "text": "THIGHS", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/legs.png", "value": "THIGHS" }, { "text": "NECK", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/neck.png", "value": "neck" }, { "text": "BUTT", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/other-butt-1.png", "value": "BUTT" }, { "text": "ABDOMEN", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_3.png", "value": "ABDOMEN" } ] }, { "id": "hydrafacial-services", "type": "button-selection", "question": "What do you want to treat with Hydrafacial?", "canSelectMultiple": false, "target": "treatment-count", "answers": [ { "text": "FINE LINES", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2023/09/ReplenishLostVolume_wmh2tw.png", "value": "FINE-LINES" }, { "text": "ELASTICITY", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2023/10/cheeklines-1.png", "value": "ELASTICITY" }, { "text": "DULLNESS", "icon": "https://storage.googleapis.com/laseraway-dev.appspot.com/2021/08/9c9c2ad2-dullness.svg", "value": "DULLNESS" }, { "text": "AGE SPOTS", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2023/09/agespots_ul67hi.png", "value": "AGE-SPOTS" }, { "text": "HYPERPIGMENTATION", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2023/09/hyperpigmentation_dtopoi.png", "value": "HYPERPIGMENTATION" }, { "text": "PORES", "icon": "https://storage.googleapis.com/laseraway-dev.appspot.com/2021/08/c187f1f4-pores.svg", "value": "PORES" }, { "text": "MELASMA", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2023/10/melasma.png", "value": "MELASMA" }, { "text": "CONGESTION", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2022/12/Layer_1-1.png", "value": "CONGESTION" }, { "text": "TEXTURE", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2023/10/texture.png", "value": "TEXTURE" } ] }, { "id": "potenza-rf-microneedling-services", "type": "button-selection", "question": "What best describes your main concern?", "canSelectMultiple": false, "target": "treatment-count", "answers": [ { "text": "FINE LINES", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2023/09/ReplenishLostVolume_wmh2tw.png", "value": "FINE-LINES" }, { "text": "COLLAGEN LEVEL", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2021/08/collagen-level.png", "value": "COLLAGEN-LEVEL" }, { "text": "PORES", "icon": "https://storage.googleapis.com/laseraway-dev.appspot.com/2021/08/c187f1f4-pores.svg", "value": "PORES" }, { "text": "TEXTURE", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2023/10/texture.png", "value": "TEXTURE" }, { "text": "LOOSE SKIN", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2023/12/loose_skin_icon.svg", "value": "LOOSE-SKIN" }, { "text": "OTHER", "icon": "https://storage.googleapis.com/images-la/sites/www/wp-content/uploads/2023/12/other_face_icon.svg", "value": "OTHER" } ] }, { "id": "treatment-count", "question": "How many times have you had this treatment?", "type": "button-selection", "target": "age-group", "answers": [ { "text": "0", "value": "0" }, { "text": "1-2", "value": "1-2" }, { "text": "3-4", "value": "3-4" }, { "text": "5-6", "value": "5-6" }, { "text": "7-8", "value": "7-8" }, { "text": "9+", "value": "9+" } ] }, { "id": "age-group", "question": "What age group are you in?", "type": "button-selection", "target": "form-name", "answers": [ { "text": "18-24", "value": "18-24" }, { "text": "25-34", "value": "25-34" }, { "text": "35-44", "value": "35-44" }, { "text": "45-54", "value": "45-54" }, { "text": "55-64", "value": "55-64" }, { "text": "65+", "value": "65+" } ] }, { "id": "form-name", "question": "What is your name", "type": "input", "target": "form-email", "inputs": [ { "name": "name", "type": "text", "placeholder": "Name", "validation": { "onChange": true, "rules": { "required": "Please provide your name", "minLength": { "value": 4, "message": "Name should containt at least 4 characters" } } } } ] }, { "id": "form-email", "question": "What is your e-mail?", "type": "input", "target": "form-phone", "inputs": [ { "name": "email", "type": "text", "placeholder": "E-mail", "validation": { "onChange": true, "rules": { "required": "Please provide your e-mail", "regex": { "value": "(?:[a-z0-9!#$%&'*+\/=?^_`{|}~-]+(?:\\.[a-z0-9!#$%&'*+\/=?^_`{|}~-]+)*|\"(?:[\\x01-\\x08\\x0b\\x0c\\x0e-\\x1f\\x21\\x23-\\x5b\\x5d-\\x7f]|\\\\[\\x01-\\x09\\x0b\\x0c\\x0e-\\x7f])*\")@(?:(?:[a-z0-9](?:[a-z0-9-]*[a-z0-9])?\\.)+[a-z0-9](?:[a-z0-9-]*[a-z0-9])?|\\[(?:(?:25[0-5]|2[0-4][0-9]|[01]?[0-9][0-9]?)\\.){3}(?:25[0-5]|2[0-4][0-9]|[01]?[0-9][0-9]?|[a-z0-9-]*[a-z0-9]:(?:[\\x01-\\x08\\x0b\\x0c\\x0e-\\x1f\\x21-\\x5a\\x53-\\x7f]|\\\\[\\x01-\\x09\\x0b\\x0c\\x0e-\\x7f])+)\\])", "message": "E-mail should be valid" } } } } ] }, { "id": "form-phone", "question": "What is your phone number?", "type": "input", "target": "form-location", "inputs": [ { "name": "telephone", "type": "text", "placeholder": "Phone", "validation": { "onChange": true, "rules": { "required": "Please provide your phone number", "regex": { "value": "^(?:\\+?1[-. ]?)?\\(?(?:[2-9][0-8][0-9])\\)?[-. ]?(?:[2-9][0-9]{2})[-. ]?(?:\\d{4})$", "message": "Please enter a valid 10-digit phone number." } } } } ] }, { "id": "form-location", "question": "What LaserAway location works best for you?", "type": "input", "lastStep": true, "inputs": [ { "name": "your-city", "type": "select", "validation": { "onChange": true, "rules": { "required": "Please select a location" } }, "mode": "dom", "querySelector": "#location-container" } ] } ] }

By providing this information you agree to the Terms & Conditions and acknowledge that the collection and use of your data will be governed by the LaserAway Privacy Policy, including, if applicable to you as a California resident, our California Privacy Notice. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.