Select Your City... Birmingham Arrowhead - AZ *Coming Soon* Avondale *NEW* Chandler Gilbert - San Tan Village Phoenix - Arcadia Scottsdale Surprise Tucson Brentwood Burlingame Castro Concord Corte Madera Dublin Emeryville Fremont Fresno Fresno - Clovis Los Gatos Milpitas Mountain View Novato Oakland Palo Alto San Carlos San Francisco - The Marina San Francisco - Union Square San Jose San Ramon Santa Rosa *Coming Soon* Tracy Walnut Creek Corona Hills Eastvale Rancho Cucamonga Bakersfield Beverly Hills Chino Hills *Coming Soon* Downtown Los Angeles Glendale Hermosa Beach Long Beach Los Feliz Marina del Rey Oxnard Pasadena Porter Ranch Santa Monica Sherman Oaks Thousand Oaks Valencia West Hollywood Whittier *Coming Soon* Woodland Hills Anaheim Hills Brea Cerritos Costa Mesa Fullerton Huntington Beach Lake Forest Mission Viejo Newport Beach Orange Tustin Davis *Coming Soon* East Sacramento Elk Grove Folsom Roseville Sacramento - Midtown 4S Ranch Carlsbad Chula Vista Del Mar *Coming Soon* Escondido Hillcrest La Jolla - UTC La Mesa Santa Barbara *Coming Soon* Temecula Boulder Belmar Centennial - Park Meadows Denver Denver - Berkeley Stamford Aventura *Coming Soon* Fort Lauderdale Jacksonville Kendall Miami - Coral Gables Miami - South Beach Orlando *NEW* Palm Beach *Coming Soon* Pembroke Pines St Petersburg *NEW* Tampa Atlanta - Buckhead Atlanta - Midtown Peachtree *NEW* Honolulu Boise Chicago - Bucktown Chicago - Deer Park *Coming Soon* Chicago - Elmhurst Chicago - Lincoln Park Chicago - River North Chicago - West Loop Evanston Naperville Northbrook Indianapolis Kansas City Wichita Lexington *Coming Soon* Baltimore *NEW* North Bethesda Boston - Fenway Somerville Wellesley Woburn Detroit-Birmingham *NEW* Edina St Louis Omaha *NEW* Henderson Las Vegas - Town Square Summerlin Clifton Edgewater Englewood Hoboken Summit *Coming Soon* Albuquerque Scarsdale Brooklyn - Brooklyn Heights Brooklyn - Park Slope Brooklyn - Williamsburg Long Island - Garden City Long Island - Manhasset *Coming Soon* Long Island - Woodbury Manhattan - Flatiron Manhattan - Meatpacking Manhattan - Morningside Heights Manhattan - TriBeCa Manhattan - Upper East Side Manhattan - Upper West Side Queens - Astoria Charlotte Charlotte-Ballantyne Raleigh Cincinnati *Coming Soon* Cleveland-Pinecrest *NEW* Columbus Oklahoma City Beaverton Portland - Tigard Philadelphia - Jenkintown *Coming Soon* Philadelphia - Main Line Philadelphia - Rittenhouse Nashville Austin - East Side Austin - The Domain Arlington - TX Dallas Fort Worth Fort Worth - Alliance Town Center *NEW* Frisco Prosper Rockwall Southlake El Paso Friendswood Houston Houston - Houston Heights Sugar Land The Woodlands San Antonio - Alamo Ranch San Antonio - La Cantera Riverton *Coming Soon* Salt Lake City - Downtown Salt Lake City - Murray Alexandria Arlington - VA Ashburn Reston Richmond Tysons Kirkland Seattle Washington DC - Cathedral Heights Washington DC - The Yards Madison

{ "settings": { "formType": "standard", "useServiceHiddenField": false, "showStepsIndicator": true, "showAccolades": true, "fullWidthFormStep": true, "showLegalConsentText": true, "backButton": true }, "steps": [ { "id": "services", "type": "button-selection", "question": "Which one are you interested in?", "dynamicTarget": true, "nextButtonText": "Next", "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", "commonStep": true, "target": "age-group" }, { "id": "age-group", "commonStep": true, "target": "form-zipcode" }, { "id": "form-zipcode", "question": "What is the Zip Code of your preferred location?", "target": "your-city", "type": "input", "layoutClasses": "grid grid-cols-1 xs:flex xs:flex-wrap", "inputs": [ { "name": "zipcode", "type": "zipcode", "validation": { "onChange": true, "rules": { "required": "Please provide your zip code", "regex": { "value": "^\\d{5}(?:[-]\\d{4})?$", "message": "Zip code must have either 5 or 9 digits (plus hyphen)" }, "zipcode": "Please make sure you enter a valid zipcode" } } } ] }, { "id": "your-city", "question": "Choose your nearest location.", "target": "form-name", "type": "nearest-locations", "layoutClasses": "grid grid-cols-1 xs:flex xs:flex-wrap" }, { "id": "form-name", "commonStep": true, "target": "form-email" }, { "id": "form-email", "commonStep": true, "target": "form-phone" }, { "id": "form-phone", "commonStep": true, "lastStep": true } ] }

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.