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    • HOME
    • INJECTABLES
      • WHAT DO I NEED?
      • Vampire Facelift® & PRP
      • Kybella®
      • Botox®/Xeomin®/Jeuveau®
      • Belotero Balance®
      • Juvederm®
      • Revanesse® Versa™
      • Radiesse®
    • ESTHETICS
      • Spa Esthetics
      • Crepe Skin and Laxity
      • Acne Treatments
      • Skin Tightening
    • BODY
      • Overview
      • CoolSculpting®
      • Non-Surgical BBL
      • Cellulite Reduction
      • Photo Gallery
    • LASER SERVICES
      • Hair Removal
      • Skin Rejuvenation
      • Clear+Brilliant®
      • Fraxel® DUAL 1550/1927
    • PMU
    • SHOP
  • HOME
  • INJECTABLES
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  • BODY
  • LASER SERVICES
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New Patient Forms

Please choose the correct form for the service you are requesting. All patients must fill out a medical assessment before we are able to schedule you for treatment. If you have not filled out an online form previously, please help us by updating your information, as we are trying to go paperless. If you have any questions, please call 866-691-4427 for the Raleigh office or 910-232-2835 for the Wilmington office.

Medical Assessment

Misc Forms

Please use this form if you are a previous patient of Pure but are trying to help us go paperless! If you are a new patient of Pure, please go back and fill out our New Patient General History and Assessment. 

UPDATED HISTORY

This form outlines how and where Pure Cosmetics, PLLC. can use your photos taken.

PHOTOGRAPHY CONSENT

This form outlines our policies regarding anytime you purchase a service or product from Pure Cosmetics, PLLC. Feel free to refer back to this form at anytime.

SERVICE AGREMENT

Injectables Consent Forms

Botox®/Xeomin®/Jeuveau® Consent
Mesolipotherapy Consent
Hyaluronidase Consent
Dermal Filler Consent
Kybella® Consent
PRP Injection Consent

Esthetics/Body Consent Forms

Esthetics Consent
Teeth Whitening consent
CoolSculpting® Consent
PMU (Microblading/Lip Blushing) Consent

Laser Consent Forms

IPL Consent
Fraxel® 1550/1927 Consent
Clear+Brilliant® Consent
Laser Hair Consent
Nail Fungus Consent
Spider Vein Consent

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