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The Perfect Peel Informed Consent

(Aesthetics)

Date:

Patient Information

Patient Name: {{patient_first_name}} {{patient_last_name}}
Date of Birth: {{patient_birthdate}}

Treatment Information

I understand that I will be receiving The Perfect Peel, which is a medium-depth chemical peel designed to improve skin texture, reduce fine lines, and address pigmentation concerns through controlled exfoliation.

Consent Statements

Please initial each statement:

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

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Angelina Torres
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Jennifer Robinson
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Luis Escobar
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Crystal Gresham
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Kyle Hicks
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Debora Davis Willeford
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Angelina Torres

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Jennifer Robinson

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Luis Escobar

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Test Jason

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Crystal Gresham

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Kyle Hicks

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Lori Purcell

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Karen Bryant

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Debora Davis Willeford

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Stacy Monyhan

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Rita Brasler

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Amanda McIver

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Kristina Redden

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Timestamp

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December 13, 2025 1:56 pm EDT

The Perfect Peel Informed Consent Uploaded by ENNU Patient Docs - ennu-appointments@ennu.co IP 139.68.242.135