Aesthetic Authorization Letter
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:
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Botox injection scheduled for August 15, 2050, at Radiance Aesthetic Center, 3689 Deercove Drive, Dallas, Texas.
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Laser hair removal on August 22, 2050, at Radiance Aesthetic Center, 3689 Deercove Drive, Dallas, Texas.
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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]
