pr model form

photo according rights

Confirm this document gives permission to post images of results due to skin improvements, we appreciate the cooperation.

Full Name * Please enter Full Name

Phone * Please enter Phone

DOB (Date format:DD-MM-YYYY) * Please enter DOB

Photos posting approve* Please enter Photos posting approve

Email address * Please enter Email address

first treatment day (Date format:DD-MM-YYYY) Please enter first treatment day

Please specify the treatment area Please enter Please specify the treatment area

Products purchased detail * Please enter Products purchased detail

Smoking yes / no Please enter Smoking yes / no

Treatment Start .. (Date format:DD-MM-YYYY) * Please enter Treatment Start ..

Any surgeries Please enter Any surgeries

Signature of this document gives permission to post images of results due to skin improvements, we appreciate the cooperation