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Skin & Sculpt Medical Spa
Skin & Sculpt Medical Spa
  • About Us
    • Our Team
    • Photo Gallery
    • Testimonials
  • Skin Care
    • Facials Customized for You
    • Dermaplaning
    • Microdermabrasion
    • Laser Treatments
    • Skin Pen
    • Teeth Whitening
    • Chemical Peels
    • Diamond Glow
    • Secret RF Microneedling
    • Cosmetic Procedures
      • BOTOX in Knoxville
      • Xeomin
      • JUVÉDERM®
      • KYBELLA®
  • Body
    • CoolSculpting
      • What Is CoolSculpting In Knoxville TN?
      • What to expect
      • How does CoolSculpting work?
      • CoolSculpting FAQ
      • CoolSculpting Before and After
      • CoolSculpting Inquiry
    • Weight Management
      • Phentermine
      • B Complex Plus Lipotropics
  • Hair Growth
  • Products
    • ALASTIN Skincare® Information
    • Elta MD®
    • LATISSE®
    • PCA SKIN®
    • SkinMedica
    • Upneeq
  • Specials
    • Monthly Specials
    • Birthday Specials
  • Shop
    • Cart
    • Gift Card Balance
  • Forms
  • Blog
  • Contact
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  • About Us
    • Our Team
    • Photo Gallery
    • Testimonials
  • Skin Care
    • Facials Customized for You
    • Dermaplaning
    • Microdermabrasion
    • Laser Treatments
    • Skin Pen
    • Teeth Whitening
    • Chemical Peels
    • Diamond Glow
    • Secret RF Microneedling
    • Cosmetic Procedures
      • BOTOX in Knoxville
      • Xeomin
      • JUVÉDERM®
      • KYBELLA®
  • Body
    • CoolSculpting
      • What Is CoolSculpting In Knoxville TN?
      • What to expect
      • How does CoolSculpting work?
      • CoolSculpting FAQ
      • CoolSculpting Before and After
      • CoolSculpting Inquiry
    • Weight Management
      • Phentermine
      • B Complex Plus Lipotropics
  • Hair Growth
  • Products
    • ALASTIN Skincare® Information
    • Elta MD®
    • LATISSE®
    • PCA SKIN®
    • SkinMedica
    • Upneeq
  • Specials
    • Monthly Specials
    • Birthday Specials
  • Shop
    • Cart
    • Gift Card Balance
  • Forms
  • Blog
  • Contact

Patient Personal Health History

  • List all prescription and over the counter medications, herbs and vitamins you take on a regular basis.
  • List names of medicines or foods that have resulted in an unfavorable reaction. State reaction.

  • Personal Health History

    Check all that apply
    Check all that apply
  • Please list the type and date of any surgeries, hospitalizations, or serious injuries you have had.

  • To the best of my knowledge, the above information is true. I have not knowingly withheld any information about my past or present health condition.
  • MM slash DD slash YYYY
Please feel free to call us if you have any questions about our services or would like to schedule a Free Consultation.

Find us on:

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Contact Info
  • Address
    Skin & Sculpt Medical Spa
    248 North Peters Rd. Suite 3,
    Knoxville, TN 37923
  • Phone number
    865-671-3630
  • Email
    skinandsculptmedspa@yahoo.com
  • Hours
    Monday … 9:00 am – 5:00 pm
    Tuesday …10:00 am – 6:00 pm
    Wednesday … 9:00 am – 4:00 pm
    Thursday … 10:00 am – 5:00 pm
    Friday … 9:00 am – 1:00 pm
    After hours appointments available
Contact Us
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