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The Perfect Peel Informed Consent

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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.

Form Complete

Kristina Redden

594417@placeholder.ennu.co

Kristina Redden

594417@placeholder.ennu.co

Kristina Redden

594417@placeholder.ennu.co

Amanda McIver

a.mack33cg@gmail.com

Rita Brasler

ritagraham@hotmail.com

Stacy Monyhan

stacymonyhan@gmail.com

Stacy Monyhan

stacymonyhan@gmail.com

Stacy Monyhan

stacymonyhan@gmail.com

Stacy Monyhan

stacymonyhan@gmail.com

Stacy Monyhan

stacymonyhan@gmail.com

Stacy Monyhan

stacymonyhan@gmail.com

Stacy Monyhan

stacymonyhan@gmail.com

Stacy Monyhan

stacymonyhan@gmail.com

Stacy Monyhan

stacymonyhan@gmail.com

Stacy Monyhan

stacymonyhan@gmail.com

Stacy Monyhan

stacymonyhan@gmail.com

Stacy Monyhan

stacymonyhan@gmail.com

Stacy Monyhan

stacymonyhan@gmail.com

Stacy Monyhan

stacymonyhan@gmail.com

Stacy Monyhan

stacymonyhan@gmail.com

Stacy Monyhan

stacymonyhan@gmail.com

Stacy Monyhan

stacymonyhan@gmail.com

Stacy Monyhan

stacymonyhan@gmail.com

Stacy Monyhan

stacymonyhan@gmail.com

Stacy Monyhan

stacymonyhan@gmail.com

Stacy Monyhan

stacymonyhan@gmail.com

Debora Davis Willeford

deborawilleford@gmail.com

Debora Davis Willeford

deborawilleford@gmail.com

Karen Bryant

shawnalexbryant@gmail.com

Karen Bryant

shawnalexbryant@gmail.com

Karen Bryant

shawnalexbryant@gmail.com

Karen Bryant

shawnalexbryant@gmail.com

Lori Purcell

595473@placeholder.ennu.co

Kyle Hicks

kylehicks748@gmail.com

Crystal Gresham

crystaljgresham@gmail.com

Test Jason

jl.mbo.test.2016@gmail.com

Test Jason

jl.mbo.test.2016@gmail.com

Test Jason

jl.mbo.test.2016@gmail.com

Luis Escobar

l_esco@me.com

Jennifer Robinson

jen.carder1990@gmail.com

Jennifer Robinson

jen.carder1990@gmail.com

Jennifer Robinson

jen.carder1990@gmail.com

Angelina Torres

angelinatorres1031@gmail.com

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The Perfect Peel Informed Consent

The Perfect Peel Informed Consent

(Aesthetics)

Patient Information

Treatment Information

Consent Statements

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