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Get Bellafill Patient Photography Consent

C.) of Bellafill® would like your permission to use these photographs for the following purposes: 1. Training, educational, informational 2. General advertising, publicity, and promotional purposes These photographs will identify your face. However, your name, address, or other identifying information will be kept confidential in accordance with HIPAA (Health Insurance Portability and Accountability Act) regulations. CONSENT I have read and understand the information above. All of my questions .

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