Celebrity Cosmetic Dermatologist

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Do you have any pre-existing medical conditions (e.g., heart disease, diabetes, autoimmune disorders) or chronic skin conditions (e.g., psoriasis, eczema)?

Have you ever had an adverse reaction to cosmetic treatments, including lasers or ultrasound treatments?

Have you experienced any skin infections, herpes outbreaks, or cold sores in the treatment area recently?

Have you had significant sun exposure or used tanning beds in the treatment area within the past two weeks?

Do you have a history of keloid or hypertrophic scarring?

Have you undergone any facial injectable treatments (e.g., dermal fillers, Botox) in the past six months?

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Contact Info

1035 Sterling Rd, Unit 104, Herndon, VA 20170

Tel:703-840-0160

Fax:571-323-3243
primehealth1041@gmail.com

Office Hours

Monday 8:30AM–5P

Tuesday 8:30AM–5PM

Thursday 8:30AM–5PM

Friday 8:30AM–5PM

Saturday 10AM-3PM

Lunch time 12pm - 1pm

Wednesday Closed

Sunday Closed

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Celebrity Cosmetic Dermatologist

MEDICAL CONSENT FORM

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