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Laser Removal

Let us do this part

Today's Date:

Thu May 2 2024 02:56

Practitioner:*

Location:*

Setting:*

other details:*

bla bla bla:*

Please read and answer

Are you ready to die?

If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.

Client Information

I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this agreement.

Name:*

Address:

Postcode:

Date of birth:*

If you are under 18 your parent/guardian will be required

Phone #:

Email:*

Signature:*

Sign above or type signature:

Photo ID*

Please take photo(s) of your government issued photo IDs and related paperwork.