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EXHIBIT 1 Revised May 1, 2017, WRITTEN ACKNOWLEDGEMENT FORM RECEIPT OF NOTICE OF PRIVACY PRACTICES Miami Dermatology & Cosmetics I, have (1) received a copy of the Notice of the Privacy Patient Name
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Miami Dermatology & Cosmetics is a skincare clinic offering dermatology and cosmetic services.
Any individual or entity operating Miami Dermatology & Cosmetics is required to file.
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The purpose of Miami Dermatology & Cosmetics is to provide dermatology and cosmetic services to clients.
Information such as revenue, expenses, services offered, and any changes in ownership must be reported on Miami Dermatology & Cosmetics forms.
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