I consent to my picture being taken for Before and After comparison for provider use only. (initial) I consent to my FIRST name and/or likeness being used on Arctic Medical Center Website and Social Media Pages. (initial)
I certify that the above information is correct to the best of my knowledge. I will not hold my doctor or any members of the staff responsible for any errors or omission that I may have made in the completion of this form.
I, Name give my consent for any and all aesthetic procedures to be performed by a provider at Arctic Medical Center. I agree with
Also, I understand that;