Aesthetic Authorization Letter Template
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Aesthetic Authorization Letter

[YOUR NAME]
[YOUR EMAIL]

Date: August 8, 2050

Dear Dr. Mae Carr,

I, [YOUR NAME], authorize Dr. Olivia Mitchell of Radiance Aesthetic Center to carry out the following cosmetic procedures on me. This authorization covers:

  • Botox injection scheduled for August 15, 2050, at Radiance Aesthetic Center, 3689 Deercove Drive, Dallas, Texas.

  • Laser hair removal on August 22, 2050, at Radiance Aesthetic Center, 3689 Deercove Drive, Dallas, Texas.

  • Chemical peel taking place on August 29, 2050, at Radiance Aesthetic Center, 3689 Deercove Drive, Dallas, Texas.

By granting this authorization, I acknowledge that I have been informed about the procedures, including their nature, purpose, and potential risks. I understand and agree to adhere to any pre- and post-procedure instructions provided by Dr. Olivia Mitchell.

This authorization is valid from August 8, 2050, to August 31, 2050, unless I provide written notice of revocation before the end date.

For any further information or clarification, please contact me using the details below:

Name: [YOUR NAME]
Email: [YOUR EMAIL]
Phone Number: 267-692-8992
Address: 4159 Spring Avenue, Philadelphia, PA 19108

Thank you for your attention to this matter.

Sincerely,

[YOUR NAME]

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