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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