Q Microdermabrasion O Skin tightening laser (list which type) Q Chemical peels (please list which type) QO IPL QO Botox O Laser hair removal Q Dermal fillers U Cosmetic surgery QO Photorejuvenating laser (list which type) QO Body contouring/fat reduction treatment (list which type) include as much information as possible including dosage and medication format. Ex. 5mg per day / i Til Ex. CVS, 57th Street & Broadway, 212 - ### - ####, Fax (212) #88 - Heee VITAREALTH _ Prone \a3s VtAve. Fax EFTA00314098