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Get Il Renew Total Body Wellness Center Consent To Cosmetic Mesotherapy Or Injection Lipolysis Treatment 2008-2024

Or a member of the Renew medical staff. I choose to have Mesotherapy performed on the following body areas: (circle all that apply) Love Handles Abdomen Front & Back of Thighs For the purpose of: Face Buttocks Outer Thighs Neck / Chin Wrinkle Reduction Back Upper Arms Other: Local Fat Reduction Cellulite Treatment I consent to the treatment of the above areas. I acknowledge that all of my concerns and questions have been answered to my satisfaction. Init.

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