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Neurotoxin Informed Consent


Neurotoxin Informed Consent Form

I understand that I will be injected with Botulinum A Toxin (Botox, Xeomin, Dysport, Jeuveau) at Primary Medical of Kentucky to paralyze my muscles temporarily. Please read and initial at the bottom of this document to indicate agreement with each of the statements below:

Consent Statements

I understand that Botulinum A Toxin (Botox, Xeomin, Dysport, Jeuveau) injection has been FDA approved for use in cosmetic treatments.

I understand that the injection of Botulinum A Toxin (Botox, Xeomin, Dysport, Jeuveau) into small muscles causes those specific muscles to halt their function (be paralyzed), thereby improving the appearance of the wrinkles.

I understand that paralysis is temporary, and re-injection is necessary within three to four months.

I understand that more than one injection may be needed to achieve a satisfactory result. It has been explained to me that other temporary and more permanent treatments are available.

I understand that the possible side effects of Botulinum A Toxin (Botox, Xeomin, Dysport, Jeuveau) include but are not limited to swelling, rash, headache, local numbness, pain at the injection site, bruising, respiratory problems, allergic reaction, infection, scarring, flu-like symptoms with mild fever, back pain, bronchitis or sinusitis, nausea, dizziness, and tightness or irritation of the skin.

I understand that the above list is not meant to be inclusive of all possible risks associated with Botulinum A Toxin (Botox, Xeomin, Dysport, Jeuveau) as there are both known and unknown side effects associated with any medication or procedure.

I understand that many people with chronic headaches or migraines often get relief from Botulinum A Toxin (Botox, Xeomin, Dysport), but that a small percentage of patients get headaches following treatment with Botulinum A Toxin (Botox, Xeomin, Dysport, Jeuveau), for the first day. In a very small percentage of patients, these headaches can persist for several days or weeks.

I understand that weakness of muscles adjacent to the treated area may occur because of the spread of the toxin.

I understand that it is important that I follow all aftercare instructions as it is crucial I do so for healing.

I understand that Botox is not an exact science, and there may be an uneven appearance of the face with some muscles more affected by the Botulinum A Toxin (Botox, Xeomin, Dysport, Jeuveau) than others.

I understand that in most cases uneven appearance can be corrected by injecting Botulinum A Toxin (Botox, Xeomin, Dysport, Jeuveau) in the same or nearby muscles. However, in some cases, this uneven appearance can persist for several weeks or months.

I understand that Botulinum A Toxin (Botox, Xeomin, Dysport, Jeuveau) should not be administered to a pregnant or nursing woman.

I understand there is no guarantee of the results of any treatment.

I understand the regular charge applies to all subsequent treatments.

I understand and agree that all services rendered to me are charged directly to me and that I am personally responsible for payment. I further agree in the event of non-payment, to bear the cost of collection, and/or court cost and reasonable legal fees, should this be required.

By signing below, I agree with the following: I have read or have had read to me the contents of this whole form. I understand the benefits, risks, and alternatives involved in this procedure and I have had the opportunity to ask questions and all my questions have been answered. I accept full responsibility for the decision to have the Botox procedure done and understand that there is no refund policy. By signing below, I acknowledge that I have read the foregoing informed consent and agree to the treatment with its associated risks. I hereby give consent to perform this and all subsequent treatments with the above understood. I hereby release the doctor, the person injecting the Botulinum A Toxin (Botox, Xeomin, Dysport, Jeuveau).

Patient Information & Signature

[esigfullsignature]

Medical Services provided by Primary Medical of KY, P.S.C., Elite Health Services, P.A., Co., Primary Medical of IN, P.C. 2025.3.12

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Farida Shadman
(Awaiting Signature)

Farida Shadman
(Awaiting Signature)

Farida Shadman
(Awaiting Signature)

Farida Shadman
(Awaiting Signature)

Farida Shadman
(Awaiting Signature)

Farida Shadman
(Awaiting Signature)

Farida Shadman
(Awaiting Signature)

Farida Shadman
(Awaiting Signature)

Farida Shadman
(Awaiting Signature)

Farida Shadman
(Awaiting Signature)

Farida Shadman
(Awaiting Signature)

Farida Shadman
(Awaiting Signature)

Farida Shadman
(Awaiting Signature)

Farida Shadman
(Awaiting Signature)

Farida Shadman
(Awaiting Signature)

Farida Shadman
(Awaiting Signature)

Farida Shadman
(Awaiting Signature)

Amany Ismail
(Awaiting Signature)

Farida Shadman
(Awaiting Signature)

Farida Shadman
(Awaiting Signature)

Amany Ismail
(Awaiting Signature)

Amany Ismail
(Awaiting Signature)

Farida Shadman
(Awaiting Signature)

Farida Shadman
(Awaiting Signature)

Amany Ismail
(Awaiting Signature)

Amany Ismail
(Awaiting Signature)

Farida Shadman
(Awaiting Signature)

Farida Shadman
(Awaiting Signature)

Amany Ismail
(Awaiting Signature)

Amany Ismail
(Awaiting Signature)

Farida Shadman
(Awaiting Signature)

Farida Shadman
(Awaiting Signature)

Amany Ismail
(Awaiting Signature)

Amany Ismail
(Awaiting Signature)

Farida Shadman
(Awaiting Signature)

Farida Shadman
(Awaiting Signature)

Amany Ismail
(Awaiting Signature)

Sierra Montgomery
(Awaiting Signature)

Sierra Montgomery
(Awaiting Signature)

Sierra Montgomery
(Awaiting Signature)

Sierra Montgomery
(Awaiting Signature)

Sierra Montgomery
(Awaiting Signature)

Sierra Montgomery
(Awaiting Signature)

Sierra Montgomery
(Awaiting Signature)

Sierra Montgomery
(Awaiting Signature)

Sierra Montgomery
(Awaiting Signature)

Sierra Montgomery
(Awaiting Signature)

Sierra Montgomery
(Awaiting Signature)

Sierra Montgomery
(Awaiting Signature)

Sierra Montgomery
(Awaiting Signature)

Sierra Montgomery
(Awaiting Signature)

Joellen Doherty
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Joellen Doherty
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Joellen Doherty
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Joellen Doherty
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Joellen Doherty
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Joellen Doherty
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Erin Ballard
(Awaiting Signature)

Cheyenne Ramos
(Awaiting Signature)

Breeann Wood
(Awaiting Signature)

Caitlin Protenic
(Awaiting Signature)

Caitlin Protenic
(Awaiting Signature)

Maranda Scott
(Awaiting Signature)

Maranda Scott
(Awaiting Signature)

Maranda Scott
(Awaiting Signature)

Maranda Scott
(Awaiting Signature)

Maranda Scott
(Awaiting Signature)

Maranda Scott
(Awaiting Signature)

Maranda Scott
(Awaiting Signature)

Taylor Rhea
(Awaiting Signature)

Taylor Rhea
(Awaiting Signature)

Taylor Rhea
(Awaiting Signature)

Taylor Rhea
(Awaiting Signature)

Taylor Rhea
(Awaiting Signature)

Taylor Rhea
(Awaiting Signature)

Taylor Rhea
(Awaiting Signature)

Taylor Rhea
(Awaiting Signature)

Taylor Rhea
(Awaiting Signature)

Taylor Rhea
(Awaiting Signature)

Taylor Rhea
(Awaiting Signature)

Taylor Rhea
(Awaiting Signature)

Jessica Brooks
(Awaiting Signature)

Krissy Impullitti
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Bailey Webb
(Awaiting Signature)

Jordan Mannel
(Awaiting Signature)

Bailey Webb
(Awaiting Signature)

Paula Wheatley
(Awaiting Signature)

Demitry Kolensnyk
(Awaiting Signature)

Anthony Linde
(Awaiting Signature)

Brittney Potter
(Awaiting Signature)

Kayla Wagner
(Awaiting Signature)

Jessica Steiger
(Awaiting Signature)

Jessica Steiger
(Awaiting Signature)

Heather Garrow
(Awaiting Signature)

Karen Bridges
(Awaiting Signature)

Maddie Vandgrift
(Awaiting Signature)

Beth Carver
(Awaiting Signature)

Traci Plonski
(Awaiting Signature)

Victoria Brown
(Awaiting Signature)

Amber Jones
(Awaiting Signature)

Caitlin Bell
(Awaiting Signature)

Kristen Smith
(Awaiting Signature)

Lacey Ruzanka
(Awaiting Signature)

Jamie Keeling
(Awaiting Signature)

Jamie Keeling
(Awaiting Signature)

Sylinia Graf
(Awaiting Signature)

Emily Burton
(Awaiting Signature)

Jennifer Price
(Awaiting Signature)

Mary Ann Locke
(Awaiting Signature)

Shari House
(Awaiting Signature)

Micaela Nocito
(Awaiting Signature)

Robert Albaugh
(Awaiting Signature)

Micaela Nocito
(Awaiting Signature)

Robert Albaugh
(Awaiting Signature)

Stephanie Smither
(Awaiting Signature)

Stephanie Smither
(Awaiting Signature)

Melissa Ritchie
(Awaiting Signature)

Amy Faith
(Awaiting Signature)

Hailey Wendelgast
(Awaiting Signature)

Tina Gaskins
(Awaiting Signature)

Melissa Ritchie
(Awaiting Signature)

Tina Gaskins
(Awaiting Signature)

Amy Faith
(Awaiting Signature)

Hailey Wendelgast
(Awaiting Signature)

Kristina Redden
(Awaiting Signature)

Kristina Redden
(Awaiting Signature)

Shelby Wetterau
(Awaiting Signature)

Mackenzie Cornish
(Awaiting Signature)

Kacy Nalley
(Awaiting Signature)


Signature Certificate
Document name: Neurotoxin Informed Consent
lock iconUnique Document ID: 7a16759b7548d5fbe7c45124a7d3bb99ae922eda
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Jolene Ballard
Party ID: 7a67beb4-82a6-46d1-b58a-21cb4d7bdbd4
Awaiting signature
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Lainey Hayden
Party ID: bcb6b989-e7af-4a69-9b54-d067b84fa30b
Awaiting signature
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Allyson Rodriguez
Party ID: 2802ad8d-fdbe-4feb-b292-9ff2e9b3d251
Awaiting signature
Z
Chandri Rai
Party ID: 10d113ae-44e9-456d-810b-a62b8f4bd38f
Awaiting signature
Jasmine Standridge
Party ID: a86e5170-a242-4ac6-9092-b0c950350067
Awaiting signature
Beth Phelps
Party ID: ddaa466f-bbcc-4c26-8d12-a733c1bec38c
Awaiting signature
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Laney Brittingham
Party ID: 7a9f9cac-ef43-4eb9-a853-b69301cc8345
Awaiting signature
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Madelyne Smith
Party ID: 5b7ce1e0-554b-4174-ac2f-19472174618f
Awaiting signature
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Kristin Weddle
Party ID: 73c99177-fd9f-4556-b3c3-795c53da751a
Awaiting signature
Kerstin Cornelius
Party ID: 245f8e00-5539-44bf-8fbb-2c80aac528dc
Awaiting signature
Holly Ward
Party ID: 51c74fc9-e246-4131-84a4-af867750cd91
Awaiting signature
Alexandria Cooper
Party ID: 64c3b3b1-2e83-40bc-abc1-432b4c5b8336
Awaiting signature
Sabina Abdalova
Party ID: 42898845-a344-49af-aa7e-5684ddfff1c4
Awaiting signature
ASV6TBDHJEelAAAAAElFTkSuQmCC
Madison Reynolds
Party ID: cc3f4936-26fd-4296-859f-c7fbd889a066
Awaiting signature
Whitley Lehman
Party ID: 6636057f-c3be-42e0-abb5-a1f8cc292e9d
Awaiting signature
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Hannah Creak
Party ID: eb3bc398-9646-4eb9-bbb6-cdccc25e4029
Awaiting signature
Sarah Bond
Party ID: e4437475-fe15-4801-a74f-1a72a51e5325
Awaiting signature
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Nijah Morrissette
Party ID: 84f4b36f-1576-44c7-8885-c6fe636a1f91
Awaiting signature
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Lauren Edwards
Party ID: c9434d81-eebe-48e4-aa32-c2632259028d
Awaiting signature
Hayley Shipton
Party ID: 83e8015c-bc5a-4543-ab0d-17a3779fff34
Awaiting signature
Malisa Cazares
Party ID: eb544a26-98f0-494c-9a76-0c5cb259259d
Awaiting signature
Katie Snider
Party ID: 1c97b14e-8c47-42aa-9c3a-98962a181e11
Awaiting signature
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Jacqueline Duvall
Party ID: 7a9f4adb-98ad-46b9-be61-980d04a6e982
Awaiting signature
Crystal Tisme
Party ID: 7ffc535c-65d0-417c-a42e-d69ed055eb5a
Awaiting signature
Kaylee Aebersold
Party ID: 9fd804b9-8a26-42a5-a271-7211ad0f170b
Awaiting signature
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Party ID: 88cc5002-2d2a-4726-b618-e4ad429f86e2
Awaiting signature
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Angela Blevens
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Awaiting signature
Emily Corbett
Party ID: 6fd2f9ab-3175-4aa0-8721-28a77b441906
Awaiting signature
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Party ID: d8fedd74-2fb5-4995-adbb-32110cba2bd3
Awaiting signature
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Sarah Wooten
Party ID: 859861cd-29ce-4be0-b4f1-380401d6601b
Awaiting signature
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Not Checkedfalen Hayden
Party ID: 11e6f490-1b7e-4815-a547-02c85640043c
Awaiting signature
ENNU Patient Docs
Party ID: 99cf213d-eb99-4009-90a9-c0126770f20b
Awaiting signature
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Amber Zurkuhlen
Party ID: b54188b3-5843-4c29-9b45-9e5fd2fb151b
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Patricia Proctor-Lile
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Claire Fedele
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Tye Lewis
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Kasha Skiles
Party ID: e6157bbc-c075-4ff2-9084-b119912acd26
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Party ID: 2efd62f5-4d08-472d-a41b-dd463fa58e4f
Awaiting signature
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Party ID: 4abf854f-ecd2-4c80-acd0-c76457425345
Awaiting signature
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Sydney Sayre
Party ID: b86746ee-13aa-4a56-8b69-32a8204425fd
Awaiting signature
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Lauren Cahalan
Party ID: b5a47954-8ad8-4da7-9b18-7344ec580f2d
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Party ID: a0b92ba8-5e6c-4db2-97e8-78df40419285
Awaiting signature
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Hope Birk
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Awaiting signature
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Katelyn Clark (flechler)
Party ID: 61264dfe-0b9b-4b8f-897d-cb14c70d57de
Awaiting signature
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Shelby Fuller
Party ID: 89f4af49-5fa6-4eb3-8192-9c4b60af6cd1
Awaiting signature
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Party ID: 7094f52e-d40c-4d35-9a0e-55cad61644f8
Awaiting signature
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Luis Escobar
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Awaiting signature
Hope Birk
Party ID: d0054c12-1fb1-4191-a33c-951b9b96a954
Awaiting signature
Ava Peters
Party ID: 1ff37cfd-4118-4aed-8fb8-569baeee74f8
Awaiting signature
Lisa Holland
Party ID: 1cdba1f3-fafa-4394-b08e-8ea238b52550
Awaiting signature
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Jason Stalvey
Party ID: dee81f6e-13c9-4c7c-806a-d722cd1d96d5
Awaiting signature
Jakgrid Lerdgidkjon
Party ID: ec032013-cfff-445c-9c71-4a95b4213ac8
Awaiting signature
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Summer Chapman
Party ID: cdbc37c5-a833-47a4-83ec-f5d9cd615aca
Awaiting signature
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Makenzie Barnes
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Awaiting signature
Maggie Jacobs
Party ID: aeb459f2-ab69-4d71-8405-9e3994ddd401
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Libby Smith
Party ID: 84ac7660-e75d-4a7f-a986-6e8d38ce98bc
Awaiting signature
Stacey Vick
Party ID: 0e814f32-4fb2-49ff-be58-0b4b01afddc5
Awaiting signature
Janie Dawson
Party ID: bed8283b-4d97-4ec3-a619-f63e5a60697f
Awaiting signature
luistest escobartest
Party ID: 897e5ab7-b744-4827-a910-b5c87923ba2a
Awaiting signature
Keniesha Watkins
Party ID: 2f3f4f69-6d8e-47df-afdf-acb28784c684
Awaiting signature
p2AAAAABJRU5ErkJggg==
Glenda Massey
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Awaiting signature
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Karleigh Rapson
Party ID: 5ac93189-ade9-4d80-8505-9d38126361db
Awaiting signature
qzoAAAAAElFTkSuQmCC
Jolene Barnes
Party ID: f0b7d539-f230-4179-99f3-eabbe9e5dc19
Awaiting signature
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Jill Pryor
Party ID: 7390b97a-a0d6-401c-ba3d-496eba036238
Awaiting signature
Catherine Pusateri
Party ID: 9162cf91-a8b1-42f4-9fb4-e016b7f39fbe
Awaiting signature
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Hailey Seabolt
Party ID: d563bfb4-40ed-4697-9b70-5188d7a15717
Awaiting signature
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Jennifer Mitchell
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Claudia Fiorello
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Katherine Hillerich
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Haley Terrell
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Macauley Murphy
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Rozena Nan
Party ID: 621a0ad2-a9a9-40b8-a619-37caee7f8390
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Mckenzie Schnarr
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Kirsten Knoop
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Kelsey Mallory
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Ann Bennett
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Megan McClurg
Party ID: 3f9c38c6-5b27-46f4-8a4e-b5fe8d4566d4
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Amy Whitby
Party ID: 2323d9e7-7a0b-43a4-a0a6-8f7075b45428
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Mary Williams
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Madison Druin
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Elizabeth Janes
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Jamie M Cassidy
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Michelle Phillips
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Renee Subletette
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Kylie Faust
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Patricia Hecker
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Melisa Lee
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Sonja Ison
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Ashleigh-jo Albert
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Beth Huff
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Bailey Weber
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Taylor Cox
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Alexis Holt
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Kelsey Legg
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Brooke King
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Amanda Maum
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Taylor ODaniel
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Alexander O'brien
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Olivia Sprague
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Danae Bracksieck
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Marcia Schmidt
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Micah Webb
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Andrea Beatty
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Cassidy Cassidyla
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Kimberly McKinley
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Matt Hodge
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Angel Smedley
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Lainie Sewell
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Sydney Davis
Party ID: 564abef6-cf3e-4535-927f-5812c4007a71
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Carrie Emerson
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Emily Rivera
Party ID: 4a5d685b-fefb-4cd4-aefb-f11c06ba7b6a
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Mark Lamkin
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Renee Elkhatib
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Phyllis White
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Michelle Bitner
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Zach Callery
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Krista Aldred
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Courtney Zurkuhlen
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Gina Jacobs
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Michaela Arnold
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Santiago Ramirez
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Rima Khatib
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Sydney Springfield
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Cathy Angelini
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Ashley Recktenwald
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Stephen Long
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Hannah Highly
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Lauren Protzer
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Michelle Jones
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shelby renfro
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Heather Rueff
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Meg Washington
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Brandy Dillard
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Tara White
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Dawn Ingalls
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Brenda Van Arsdale
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Madison Wood
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Makenzie Moore
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Ashley Sims
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Olivia Napier
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Marcos Villarreal
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Joshua Frank
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Brianna Jones
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Alex Depriest
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Leigh Nieves
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Alivia Stewart
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Hannah Huff
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Jade Kot
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Rebekah Robbins
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Madilyn Neuling
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Jennifer Bynum
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Lynne Wilson-gault
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Kynleigh Watson
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Kristen Cook
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Lyndsey Newport
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luistest escobartest
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Carly Rizzo
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Carter Sparks
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Darcee Nice
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Kathryn Salama
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Kasey Gutgsell
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Angie Rhude
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Monika Douglas
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Erica Winfield
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Renee McGill
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Cindy Clegg
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April Self
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Luis Escobar
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Trent Ennenbach
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Cara mathis
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Melody Guthrie
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Alley Puckett
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Tanya Helm
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Makenzie Gibbs
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Claudia Suarez
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Kelly Short
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Tiffany Mattingly
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Natalie Myers
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Taylor Siemens
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Kaylea Percal
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Mary Bell
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Bart McHenry
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Olivia Makk
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Tracy Ander
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Michaela Smith
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Allison Napier
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Simone Douglas
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Lindsey Herald
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Morgan Michels
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Gabrielle Thompson
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Jessica Venturi
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Morgan Michels
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Anna McDonough
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Marissa Degrella
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Stephanie Claxton
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Wes Parrish
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Taylor Moore
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Megan Keane
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Sarah Jackson
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Whitney Mcnicol
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Jessica Reed
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Kasey Wilmsmeyer
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Tori Raley
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Erin Getz
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Courtney Hamilton
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Victoria Barr
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Karen Thompson
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Iraida Estrada Moreno
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Shelby Hall
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Gina McRae
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Olivia Boose
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Jennifer Pineda
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Alonzo Lewis Walker
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Cortney Snider
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Angie Ware
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Candace Gilbert
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Dilaram Temirova
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Maggie Lambert
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Tami Farmer
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Heather Weber
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Katelyn Tessmer
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Sarah Belew
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Breanna Devine Hopkins
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Victoria Riggs
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Trinity McKinney
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Rebekah Neeley
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Mervat Jaber
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Marcia Graft
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Sondrah Laden
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Jennifer Bame
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Halle Gibson
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Kaitlin Knopp
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Leslie Dieckhoff
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Saleah Farias
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Kim Williams
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Hannah Holland
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Anouk Guilmineau
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Jeryl Trail
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Alexus Allen
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Jessica Dickey
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Angie Taylor
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Rubi Ortuno
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Chrissy Crutcher
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Olivia Whitlock
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Patricia Kolb
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Denise Holloway
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Ashley Epstein
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Crystal Coddington
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Megan Collins
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Jennifer Castellano
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April Kovacs
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Leah Bearden
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Ashley Pulver
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Brianne Kilner
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Abby Reed
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Rylie Tharp
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Stacey Fenkel
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Olivia Bricker
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Alyssa Freitas
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Michele Huff
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Angelina Torres
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Jordan Shellhaas
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Jordan Skora
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Rachel Shive
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Jordan DeJarnette
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Lindsay Ratterman
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Diana Silliman
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Mary Gullett
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Britney Kennedy
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Amy Nein
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Liz Winters
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Kyle Hicks
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Kegan Wesley
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Jea Lorena Sword
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Drew Pherson
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lilly sipes
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Lainey Nickol
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Farida Shadman
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Amany Ismail
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Sierra Montgomery
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Joellen Doherty
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Erin Ballard
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Cheyenne Ramos
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Breeann Wood
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Caitlin Protenic
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Maranda Scott
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Taylor Rhea
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Jessica Brooks
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Krissy Impullitti
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Jordan Mannel
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Bailey Webb
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Paula Wheatley
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Demitry Kolensnyk
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Anthony Linde
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Brittney Potter
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Kayla Wagner
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Jessica Steiger
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Heather Garrow
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Karen Bridges
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Maddie Vandgrift
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Beth Carver
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Traci Plonski
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Victoria Brown
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Amber Jones
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Caitlin Bell
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Kristen Smith
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Lacey Ruzanka
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Jamie Keeling
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Sylinia Graf
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Emily Burton
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Jennifer Price
Party ID: 8bbb3379-f5d2-4436-bf05-46103ecb361c
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Mary Ann Locke
Party ID: cf4a63ce-088d-4ef8-b763-95fa387a51a9
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Shari House
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Micaela Nocito
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Robert Albaugh
Party ID: ab618b02-9c17-425a-a713-7484a652739d
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Stephanie Smither
Party ID: 8ca312dd-fc9c-44fd-b3e6-50b67f0c53e8
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Melissa Ritchie
Party ID: 05a2c422-dd6a-4e3c-8c66-24ab03a4cf04
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Amy Faith
Party ID: 9ea4acbf-bcf1-4685-8bc4-e77de97df8ee
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Hailey Wendelgast
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Tina Gaskins
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Kristina Redden
Party ID: 59d50c59-5708-4dea-bb65-9ec8c3fc1121
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Shelby Wetterau
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Mackenzie Cornish
Party ID: 4247a55a-d90b-40a2-b8d1-70bc376be171
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Kacy Nalley
Party ID: 2f232845-a5ca-475e-b535-a5591dadcbcc
Awaiting signature
Timestamp Audit
December 13, 2025 1:56 pm EDTNeurotoxin Informed Consent Uploaded by ENNU Patient Docs - admin@ennulife.com IP 139.68.242.135
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