EVALUATION FORM

By providing my phone number, I agree to receive text messages from CG Cosmetic. By submitting, I consent to receiving occasional notifications and promotional messages by text and email. You can opt-out by replying "STOP". I also acknowledge that I have read and agree to the Terms & Conditions. Please read our Privacy Policy here.

CG Cosmetic offers patients the opportunity to communicate by email, phone call and mobile text messaging. Transmitting patient information by email, phone call and mobile text messaging has a number of risks that patients should consider before granting consent to use email, phone call and mobile text messaging for these purposes. CG Cosmetic will use reasonable means to protect the security and confidentiality of email, phone call and mobile text messaging information sent and received. However, CG Cosmetic cannot guarantee the security and confidentiality of email, phone call and mobile text messaging communication and will not be liable for inadvertent disclosure of confidential information.

I acknowledge that I have read and fully understand this consent form. I understand the risks associated with communication of email, phone call and mobile text messaging between CG Cosmetic and me and consent to the conditions outlined herein. Any questions I may have had were answered.