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400 Indiana Street 380 Golden CO 80401 720-420-4090 www. accentaesthetics. com Name Birthdate Address Cell Phone Home Phone Email Address Emergency Contact Name Number Can we send you emails about upcoming specials and events Yes / No Can we text appointment reminders Yes / No How did you hear about us Female Clients Are you pregnant or trying to become pregnant Y / N Are you breastfeeding Y / N What skin problems concern you the most Sun Damage Upper lip lines Acne/ Oily Skin Unwanted Hair...
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