By submitting this form, you confirm that all the information provided is accurate and complete to the best of your knowledge. You acknowledge that any inaccuracies or omissions may affect the suitability and safety of your prescribed skincare treatment.
Miriderma Skin + Wellness cannot be held responsible for any adverse effects or complications arising from incomplete or incorrect information provided in this consultation. If your medical history, medications, or allergies change at any point, it is your responsibility to inform us before continuing any prescribed skincare treatments.
🔒 All information provided is strictly confidential and will only be used to ensure your skincare treatment is safe and effective.