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Get Radiesse Patient Access Program

E RADIESSE injectable implant provided under this application only to the patient listed below for the FDA-approved indication listed above and for no other purpose. I certify that the product provided hereunder will not be resold nor offered for sale, trade or barter and will not be returned for credit. To the best of my knowledge, the patient for whom I am requesting RADIESSE under this application has no insurance coverage, whether private or governmental, for RADIESSE treatment. I understand.

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