Ayur-Medic

for your interest in the Ayur-Medic product line. We are very interested in hearing from you. Please provide us with the information below and we'll send you information.

If you prefer to speak to us directly, please call us at 1-800-357-5280
or write to us at

Ayur-Medic
2488 Townsgate Road, Suite A
West Lake Village, CA 91361-6116

To contact us by email, please fill out the form below:

First Name:		Last Name:
Address:		City:
State:		Zip:
Home phone:		Day Time Phone:
Fax:		E-Mail:

How would you describe your skin?

What type of procedures have you had done on your skin (such as; facials, laser, plastic surgery, etc.)?

Is there anything you would like to ask Ayur-Medic's dermatologist or plastic surgeon regarding a specific problem?
Would you like assistance in choosing the right products for your skin (a technical advisor will be calling)? yes no

Would you like to place an order at this time? yes no

Are you an esthetician or a salon owner interested in carrying Ayur-Medic products? yes no

Please use the box below to ask the Ayur-Medic Staff anything you wish to know or any comments you wish to share with us:

Phone: 1-800-357-5280 Fax: 1-805-374-8411 2488 Townsgate Road, Suite A, Westlake Village, CA. 91361