Dr. Parsa's Trifecta Giveaway Application

Thank you for showing interest in Dr. Parsa's Trifecta Giveaway!

Please keep in mind we are only considering applicants who have never had eyelid/cheek fillers or other eyelid surgeries. You must be willing to share your story on social media.

Our ideal candidate is someone with a touching story who is in need of lower eyelid surgery.

Application deadline: Monday, December 30

We will announce one winner Monday, January 13

In order to enter the giveaway:

Completely fill out this form.
Send a video (up to 1 minute) to [email protected] explaining why you want Trifecta Lift and why we should choose you as the winner. Make the email subject "Trifecta Lift Giveaway." Make sure to include your first and last name in the video so we can match your application.
Follow Dr. Parsa on Instagram. https://www.instagram.com/kamiparsamd/
"Like" and tag 3 friends in our giveaway announcement post on Instagram. https://www.instagram.com/p/DDck7VzShas/
Share the giveaway post to your IG stories.
Subscribe to Dr. Parsa's YouTube channel. https://bit.ly/47E8Ytt

Full Name *

Phone *

Email *

Address *

State *

City *

Postal code *

Date of birth *

Gender *

Details

By adding additional details about your medical history, medications, allergies, and previous cosmetic history we can navigate the best course of action to achieve your goals.

Any conditions currently watched or managed by a doctor? *

Yes

What conditions are being watched or managed by a doctor?

Describe in details, please.

Please list previous surgical procedures with dates?

Add procedure and date.

Any issues with healing or anesthesia with previous surgeries?

ex: healing, bleeding, nausea

Have you ever had eyelid surgery? *

Yes

Other Eye Surgery (please specify).

Social History

Smoking

Alcohol

Other Social History (please specify).

Any allergies?

Describe allergies

List all medications you currently take?

Let's Get Specific

Please answer the questions below to help us better develop a treatment plan for you.

When was your last Botox Treatment?

Date

I've had filler to my under-eyes. Please answer *

Yes

Dissolved

It was years ago

What under-eye filler do you have? Please get records

ex: Restylane, Juvederm, Voluma,

When did you have under-eye filler

Date

I've had filler to my cheeks. *

Yes

Dissolved

It was years ago

When did you have cheek filler? Please get records

What cheek filler do you have?

ex. Restylane, Juvederm, Voluma

I've had filler dissolved. *

Yes

Never had filler

Other Eye Health Details (please specify).

I have swelling/puffiness around my eyes that comes and goes. *

Yes

I use eye drops *

Yes

I take allergy medication

On a good day, how would you rate your eye puffiness (from a scale of 1-10). *

1 being good, 10 being worst

On a bad day, how would you rate your eye puffiness (from a scale of 1-10). *

1 being good, 10 being worst

Social Media Consent

We would love to film your journey to share on our social media channels.

If chosen, I am willing to share my journey on social media. *

Yes

Video and Photo Submission

IMPORTANT: Please send a video (up to 1 minute) to [email protected] explaining why you want Trifecta Lift and why we should choose you as the winner.

Please take a moment to take a front view photo, a 3/4 left view photo, and 3/4 right view photo. (See example below)

Upload photos here. *

Any additional information you'd like to share to better assess you?

Legal Notice for Trifecta Lift Giveaway

1. Introduction

This Legal Notice pertains to the Trifecta Lift Giveaway ("Giveaway") offered by Parsa MD Inc ("Practice"). Participation in this Giveaway implies agreement to the terms and conditions set forth below.

2. Eligibility Criteria

Participants must be legal residents of the United States and over the age of 18.
Employees of the Practice and their immediate family members are ineligible.
A completed submission form is required for entry into the Giveaway.
Entree period December 11 - 30, 2024
Winner will be notified January 13, 2025

3. Procedure Description

The Trifecta Lift is a surgical procedure. Click the link to view full details.

4. Comprehensive Risk Disclosure

Participants must understand and accept the risks associated with the Trifecta Lift, including but not limited to infection, bleeding, pain, scarring adverse reactions to anesthesia, and potential dissatisfaction with results. A detailed pre-operative consultation will be conducted.

5. Informed Consent and Release of Liability

Participants will be required to sign an informed consent form, acknowledging the risks and releasing the Practice from liability for any claims or damages related to the procedure.

6. No Monetary Compensation

The prize consists only of the Trifecta Lift procedure, is non-transferable, and cannot be exchanged for cash or other services.

7. Right to Select Winner

The Practice reserves the exclusive right to select the winner of the Giveaway. This selection will be at the sole discretion of the Practice and based on criteria established by the Practice.

8. Amendment and Termination Rights

The Practice reserves the right to amend the terms or terminate the Giveaway at any time, in accordance with California law.

9. Governing Law and Jurisdiction

This Legal Notice is governed by the laws of the State of California.

10. Photo and Video Release Consent

Participants consent to the use of their photographs and videos for medical, educational, promotional, and informational purposes.
This release applies to all media forms, and participants will not receive financial compensation for such usage.

11. Acknowledgment and Agreement

By submitting the form for the Giveaway, participants affirm their understanding and agreement to these terms, including the photo and video release consent.

I understand the terms and conditions provided by the company.