Anthony Ian Banks – ianbanks@asktel.net

Full Name: Anthony Ian Banks
Date of Birth: 1964-05-18
Email Address: ianbanks@asktel.net
Emergency Contact: Lise 306-230-7090
Medical History : Fillings / Cavities, –
Additional Details :
Have you been under the care of a dermatologist within the past year? No, –
Are you taking any medications or dietary supplements? No, –
Have you had any surgery in the last 12 months? No, –
Have you received Botox, Restylane, Collagen or any other injections in the last 6 months? No, –
Do you wear contact lenses? Yes, – Soft/ dailies
Is there anything that may be important for us to know? Recently had some physio on my rat rotator cuff/ shoulder
For ladies: Are you pregnant, planning a pregnancy, breastfeeding, using birth control or menstruating? Array
For ladies: Are you taking birth control pills? ,
Body Concerns:, –
What is your current facial care routine?

Facial concerns: , –
What is your current body care routine? Silly shower some moisturizer

Name : Ian Banks
Signature : https://www.mrvlspa.com/wp-content/uploads/ocswcf_signatures/signature-704-1651691727.png

Enter Date : 2022-05-04

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