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MY PROVIDER RELIES ON THIS INFORMATION TO PROVIDE SAFE AND EFFETIVE TREATMENT Pa ent Signature Date INFORMED PATIENT CONSENT FOR TREATMENT WITH INJECTABLE FILLERS My signature and initials after each statement below constitutes my acknowledgment that 1. I consent to and authorize scars and /or wrinkles or have any lips augmented made larger. The llers to be used include Radiesse Hylaform Collagen and/or Juvederm. The area to be treated The ller to be used 2. PATIENT INFORMATION AND MEDICAL...
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