Institute of Epidermal Cell Therapy

Patient Confidentiality Agreement


Patient Agreement

I understand that the services offered are not a substitute for medical care and any information provided by the esthetician is for educational purposes only and not diagnostically prescriptive in nature. I further understand that the information herein is to aid the esthetician in giving the most appropriate and safe treatment available and remains confidential.

Date

Client Signature

--OR--

Consent to administer treatment for Minor/Dependent: Parent/Guardian Signature

Leave this empty:

Signature arrow sign here


Signature Certificate
Document name: Patient Confidentiality Agreement
lock iconUnique Document ID: fd1a97a6518f74253b779306a21ae9e16bb4f2a3
Timestamp Audit
January 10, 2018 2:53 pm EDTPatient Confidentiality Agreement Uploaded by Michelle Bechtel - michelle7bechtel@gmail.com IP 74.98.163.149
April 5, 2019 8:12 pm EDT Document owner michelle7bechtel@gmail.com has handed over this document to Saphoniagee@estheticstherapy.com 2019-04-05 20:12:58 - 74.98.163.149