Admissions

Which program do you wish to apply for?

Advanced Dermaplaning and Chemical Peel
Advanced Microneedling

PERSONAL INFORMATION

Name *

First

Last

Date of Birth

MAILING ADDRESS

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Mobile *

Email *

Occupation

Employer

When is the best time to contact you? (check all that apply)

Morning (9am-12pm)
Afternoon (12pm-3pm)
Late Afternoon (3pm-6pm)
Evening (6pm-9pm)

EMERGENCY CONTACT

Name *

First

Last

Relationship to Student *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Mobile *

CITIZENSHIP AND LANGUAGE

I am applying as a/an

Canadian Citizen
Canadian Permanent Resident
International Student

Is English your primary language?

Yes
No

If not, how would you rate your English proficiency?

EDUCATION INFORMATION

Did you graduate from high school?

Yes
No

Are you 18 years or older?

Yes
No

What is your highest level of education? (Please specify your school and area of study)

Please specify school and area of study

Do you have any education or experience that relates to the field of aesthetics?

Yes
No

If yes, please specify

Have you studied anatomy and physiology?

Yes
No

If yes, how advanced were your studies and where did you study?

What are your personal goals for completing this course?

HEALTH INFORMATION

Do you have any health issues/problems that the Institute should be aware of?

Yes
No

If yes, please specify

Are you taking any medications that the Institute should be aware of?

Yes
No

If yes, please specify

Do you have any allergies or skin sensitivities that would prevent you from receiving medical aesthetics treatments? (ex.: psoriasis, eczema, issues with skin healing, immunosuppressed)

Yes
No

If yes, please specify

How did you hear about the Bertrand Institute of Medical Aesthetics? (check all that apply)

If other, please specify

Upon receipt of a completed form, our Admissions Department will promptly review your application. Once you have been accepted into your program of choice, a 50% non-refundable deposit is required to secure your place in the program. Final payment is due 2 weeks prior to training start date. For more information, please connect with our Admissions Department or email info@bimacanada.com.

I consent to the Bertrand Institute of Medical Aesthetics sending me relevant electronic messages including promotions, newsletters and program updates by email.
I agree to BIMA’s policies and procedures.

THIS APPLICATION HAS BEEN COMPLETED BY

ELECTRONIC SIGNATURE

Date

IMPORTANT DISCLAIMER:

The information provided is for general information and is subject to change without notice. Every effort has been made to provide accurate and complete information however Bertrand Institute for Medical Aesthetics Inc. (BIMA) makes no warranty or representation as to the accuracy of the information provided. Some of the information provided may have been provided by independent third parties and should not be assumed to be approved or endorsed by BIMA. BIMA expressly disclaims all and any liability to anyone who acts in reliance on the information provided, whether the direct recipient of such information or not. Before acting in reliance on any information provided, you are strongly advised to contact BIMA or such other person, organization or legal entity as you consider necessary or advisable to confirm that any information you are relying upon is current and accurate. BIMA will not be responsible for any loss or damage arising to you as a result of any actions taken by you in reliance on the information contained herein or for any errors or omissions. Course offerings, schedules, tuition fees, facilities and faculty are subject to change without notice. We also reserve the right to cancel or postpone classes due to inadequate enrollment.

Course Pre-requisites

Program Application Form

PERSONAL INFORMATION

MAILING ADDRESS

EMERGENCY CONTACT

CITIZENSHIP AND LANGUAGE

EDUCATION INFORMATION

HEALTH INFORMATION

IMPORTANT DISCLAIMER: