PRIVATE VERDE INTAKE

PRIVATE VERDE INTAKE

Begin your private advisory application.

Begin your private advisory application.

Begin your private advisory application.

Share the details Dr. Flora needs to understand your goals, priorities, timing, and previous experiences. Every answer helps shape a more precise VERDE Map.

Share the details Dr. Flora needs to understand your goals, priorities, timing, and previous experiences. Every answer helps shape a more precise VERDE Map.

Share the details Dr. Flora needs to understand your goals, priorities, timing, and previous experiences. Every answer helps shape a more precise VERDE Map.

Personal Information

Personal Information

First Name

Last Name

Email Address

Phone Number

City

Age

Referred By

I

I

What are your ultimate goals and aspirations — aesthetically and in longevity?

What are your ultimate goals and aspirations — aesthetically and in longevity?

What are your ultimate goals and aspirations — aesthetically and in longevity?

Please be as detailed as possible. Whether your goal is to look younger, feel healthier, optimize hormones, improve recovery, or completely redesign your aesthetic journey, every detail helps us build your VERDE Map.

Please be as detailed as possible. Whether your goal is to look younger, feel healthier, optimize hormones, improve recovery, or completely redesign your aesthetic journey, every detail helps us build your VERDE Map.

II

II

What is your most urgent concern or the areas you would like to improve first?

What is your most urgent concern or the areas you would like to improve first?

What is your most urgent concern or the areas you would like to improve first?

Tell us everything. We’ll prioritize your strategy based on what matters most to you.

Tell us everything. We’ll prioritize your strategy based on what matters most to you.

III

III

What treatments, procedures, supplements, medications, or providers have you tried previously?

What treatments, procedures, supplements, medications, or providers have you tried previously?

What treatments, procedures, supplements, medications, or providers have you tried previously?

Knowing what has and hasn’t worked allows us to build a better strategy.

Knowing what has and hasn’t worked allows us to build a better strategy.

IV

IV

Do you have any important dates, travel schedules, surgeries, vacations, or timing considerations we should plan around?

Do you have any important dates, travel schedules, surgeries, vacations, or timing considerations we should plan around?

Do you have any important dates, travel schedules, surgeries, vacations, or timing considerations we should plan around?

Understanding your timeline helps us design the safest and most effective treatment sequence.

Understanding your timeline helps us design the safest and most effective treatment sequence.

What Happens Next

What Happens Next

Every submission is personally reviewed by Dr. Flora. If your goals align with the VERDE advisory model, you will receive a response outlining the next steps for your consultation and personalized strategy.

Every submission is personally reviewed by Dr. Flora. If your goals align with the VERDE advisory model, you will receive a response outlining the next steps for your consultation and personalized strategy.