Interested in being a Kane Institute Of Advanced Aesthetics model?Submit the below form for the chance to be a Model in our Institute. Your First Name Your Last Name Your Phone Number Your Email Address Social media consent is required in order to be a model. Do you consent to your photo/video being taken and published on various social media platforms? Yes Have you had Botox treatment in the past? YesNo When were you last treated with Botox? >4 months ago<4 months agoNA Have you had dermal filler in the past? YesNo When were you last treated with dermal filler? >4 months ago<4 months agoNA What services are you interested in? Botox foreheadBotox frown linesBotox crows feetBotox massetersBotox lip flipFiller lipsFiller cheeksFiller chinFiller smile linesFiller marionette linesAll of the aboveOpen to suggestions Are you prone to fainting (especially with needles)? YesNoUnsure What is your budget for treatment? Between $100 - $500Between $500-$1000Between $1000-$1500$1500+ What is your availability to for treatment? (Date) What is your availability to for treatment? (Time) Please upload a profile photo of you (front facing with no expression)? Please upload a profile photo of you (side profile)? Please upload a profile photo of you (45 degree angle)? Please upload a profile photo of you (raising your brows)? Please upload a profile photo of you (furrowing your brows)? Please upload a profile photo of you (smiling as big as you can)?