Paramedical Consult Form

First Name *

Last Name *

Date of birth *

Email *

Phone *

I consent to receive marketing text messages from Cinnamon Girl Clinic at the phone number provided. Frequency may vary. Message and data rates may apply. Text HELP for assistance, reply STOP to opt out.

I consent to receive non-marketing text messages from Cinnamon Girl Clinic about my appointment updates, appointment reminders, etc. Message and data rates may apply.

Current Medication *

Please describe your area of concern (ex. I would like my tummy tuck scar camouflaged) *

Please add up to 3 images of your area of concern as files below

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Picture 2 Upload

Picture 3 Upload

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