Step 1
Thank you for interest shown in beneficial ICLS courses.
Can you please provide few details so that ICLS can help you in a better way?
Pl fill in and send email
Name: Date:
Age / Sex: Mobile: Res. No: Email:
Res. Address:
Office/clinic address:
Your educational background:
Your REGISTRATION NUMBER / YEAR WITH LOCAL MEDICAL COUNCIL:
What are you doing currently?
Do you want to do something different & special apart from your competitors? Yes / No
Would you like to have a separate identity for your own practice? Yes / No
Would you like to serve better class of patients who will appreciate your efforts & skills? Yes / No
Do you think you can have a better life style than what you are living currently? Yes / No
How did you get interested in this field?
Do you or your relative have any previous experience in cosmetology field? If yes, pl specify Yes / No
What are you planning to do after completing course?
Would you be interested in getting after training practice support from ICLS? Yes / No
How soon do you want to start the course?
Are you willing to learn new techniques, which can give better results to your patients? Yes / No
How would you like to do the course? By personal attendance / by correspondence
Any of your relative is Doctor? if Yes give details: / No
In which course are you interested?
1.”Advanced course in Face & Skin Treatment” (Cosmetology)
2.”Advanced course in Hair sciences” (Trichology)
3.Advanced Weight Loss Treatments’
4.”Art of Medical Practice” : 1 days workshop to learn success enhancement techniques.
Thank you.
5. Diet and Nutrition. (online course)
Pl fill in and send email
from:
Dr.Anil Nirale(M.Ch.)
Consultant Plastic & Cosmetic Surgeon
www.icls.in
Cell-9820086112
Ofice-00-91-22-28907583
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