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THEODORE L. GENTLE, M.D. 3363 Tate's Creek Rd, Suite 209 Lexington, Kentucky 40502 (859) 2792111 BROW LIFT FOREHEAD LIFT REQUEST FOR TREATMENT AND INFORMED CONSENT DO NOT SIGN THIS FORM UNTIL YOU

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Start by entering your personal information in the designated fields such as name, address, and contact details.

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