We are happy to assist you as you explore your self-improvement options.
Call us toll free at 800-769-0849
or email us at cindyg@lasercenterofwi.com

If you would you like to receive our complimentary patient information packet, or schedule a complimentary consultation with one of our board certified plastic surgeons, simply use the form below to contact us. If you prefer to request information or schedule a consultation by phone, please call us at 800-769-0849.
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Last Name:
First Name:
Street:
City:
State:
Postal Code:
Phone:
Email:
Where did you first hear about Laser Centers of Wisconsin?
Laser Centers of Wisconsin would like to follow-up with you. If you would like to be contacted, what is the preferred way for us to reach you?
  Phone
  Mailing Address
  Email
Which procedures or services are you interested in? (check all that apply)
 Facial Veins
 Leg Veins
 Rosacea
 Age Spots
 Cafe au Lait birthmark
 Port Wine Stain Birthmark
 Tattoo Removal
 Hair Removal
 Angioma
 Hemangioma
 Scar Revision
 Warts
 Stretch Marks
 Skin Care
 Cosmetic Surgery
 Laser Skin Resurfacing
 Permanent Cosmetics
If you would like to schedule a complimentary consultation, please fill in the next few questions. Otherwise, skip to the end of this contact form.
Complimentary Consultation Information Section:
Date of birth: 
What is the preferred way for us to contact you Monday-Friday to confirm your appointment?
 Phone
 Mailing address
 Email
Preferred day of the week for appointment?  
Time frame for surgery?  
Location where you would prefer your appointment?  
Physician requested:     
Please list any other specific questions that you have:
For your privacy, this information will be used solely by the Laser Centers of Wisconsin and will not be shared with any other persons or organizations.

5201 North Port Washington Rd. Milwaukee, WI 53217 · ph 414.963.0275 · fx 414.963.0667 · 800.821.5532 in Wisconsin only · Contact Us