Beautiful Date Questionnaire

This is a form for purchasers of a Beautiful Cosmetic Procedure Date. If you haven’t already placed your order, please do so here. If you’ve already placed your order, please allow 6 weeks to receive your date, unless you ordered expedited service.

Please fill out and click Submit. All information will remain completely CONFIDENTIAL.

  • Your Contact Information

  • Get this from your order confirmation email. #xxxxx.

  • Your Birth Data

  • :

  • Your Doctor's Data

  • If known.
  • Check all that apply.
  • If any. Please use American mm/dd/yyyy format.

  • Date Preferences

    Do you prefer:

  • Option A: The best date for beauty and safety within 1 year. Your date will be chosen as close to your ideal time frame indicated below as is consistent with choosing a an excellent date. * I urge you to choose this option. 30 years of research clearly shows that regardless of other considerations, it is far better to wait for a great date that will bring you maximum odds of safety and beauty.

  • OR Option B: The best date available in your time frame indicated below. *I DO NOT recommend this- but if you must....... The best date available in your specified time frame may or may not meet all stringent requirements, but will still be the best available within your limitations. Bear in mind that the longer your specified ideal time frame, the greater the chances of finding an excellent date.
  • Be SURE you'll be ready to take action by this date. Your chosen date could possibly be found on this date or shortly after.
  • Be SURE you'll be ready to take action by this date. Your chosen date could possibly be found on this date or shortly after.
  • Please use American mm/dd/yyyy format.

  • Additional Comments or Information

  • Delivery

    Your Beautiful Date will be delivered via email. Please allow 6 weeks after receipt of this completed form unless you have ordered expedited delivery. Please CHECK YOUR SPAM FOLDER beginning a few days before your date is due to be delivered.