Katie Fussner – katiefussner@kw.com

Full Name: Katie Fussner
Date of Birth: 1985-11-11
Email Address: katiefussner@kw.com
Emergency Contact: Bonnie fussner
Medical History : Other, –
Additional Details : No
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? Yes, – Botox
Do you wear contact lenses? Yes, – Contacts
Is there anything that may be important for us to know? No
For ladies: Are you pregnant, planning a pregnancy, breastfeeding, using birth control or menstruating? Array
For ladies: Are you taking birth control pills? No,
Body Concerns:, –
What is your current facial care routine? I use all skin mediCa products

Facial concerns: Aging, Dull Skin, Pigmentation, Uneven skin tone, –
What is your current body care routine?

Name : Katie Fussner
Signature : https://www.mrvlspa.com/wp-content/uploads/ocswcf_signatures/signature-704-1652287043.png

Enter Date : 2022-05-11

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