Select your age range *

18-30

31-45

46-60

61-75+

Have you been diagnosed with lichen sclerosus? *

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Do you have a family history of lichen sclerosus? *

Yes

No

I'm Not Sure

Do you have any of the following symptoms?

Intense itching

White patches of skin

Pain during sexual activity

Pain during urination

Pain during bowel movements

Scarring

Thin or wrinkled areas of skin in the genital area

Changes in the appearance of skin around the genital area

Are you a new or existing client to Blush Aesthetics? *

New Client or Existing Client

Yes, I'm New
No, I'm an existing client
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Let us know where to contact you to let you know if you’re a candidate for our lichen sclerosus treatments.

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