Set the Tone

Tone Model Application

We are looking for models to feature our great work and share their patient experiences. Apply below to receive complementary Botox or filler treatment with Dr. Robinson and be featured in our marketing materials. The promoted treatments include:

  • Botox for forehead and frown lines
  • Botox crow’s feet
  • Lip filler and under eye filler

We are looking for two patients per category. Both men and women of any age, skin type, and skin tone are welcome!

Thank you!

Your submission has been received. Thank you for your interest. We will in touch soon with more details.

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    I understand that under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), I have certain rights regarding the use and disclosure of my Protected Health Information. I have received, reviewed, and understand the Notice of Privacy Practice provided by Tone Dermatology. I knowledge that this Consent and Authorization for Use and Disclosure of Media is, and it is being provided, consistent with such Notice of Privacy Practice.

    I understand that Caroline Robinson MD and Tone Dermatology (hereinafter collectively, “Tone”) may, or will have a need to, take, use, and disclose photographs and videos of me, in electric or digital form or otherwise, (hereinafter, “media”) that constitutes Protected Health Information and represents stages of my treatment by Tone.

    I hereby consent to and authorize Tone to take, use and disclose such media to patients, prospective patients, and such other individuals as may be necessary for a marketing and educational purposes, without further limitation and for such period of time as may be determined in the discretion of Tone, including after the completion of my treatment. I hereby waive all claims for compensation or damage for such use and disclosure that are consistent with this authorization. I understand that I am under no obligation to provide my authorization and that my treatment, payment, enrollment or eligibility for benefits will not be impacted in any way by my refusal to provide such authorization. I understand that information disclosed pursuant to this authorization may be subject to redisclosure by recipient and would no longer be subject to this authorization. I may revoke this authorization at any time and for any or no reason by writing to Tone at the address below.

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