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NAME:___.Date:___Please read and initial each statement. Complete, underline or circle individual selection accordingly. I authorize Dr. Amelia Cheatham to perform IPLTM treatments on me in an effort to improve Dry Eye Disease due to Meibomian Gland Dysfunction / Dyschromia / Hyperpigmentation / Hair Reduction / PWS / Haemangioma / Angioma / Rosacea / Telangiectasia / Other ___I understand that there is a rare possibility of side effects or serious complications including permanent...
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