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Equipment Problem Form
Notify Dr Kanase Immediately.
Submitter's Name
*
Clinic
*
Amarillo
Albuquerque
El Paso
Midland
Lubbock
Corpus Christi
Event Date
*
+
Event Time
*
Machine
*
ALEX
YAG
GMax Pro
Ultrasonic
Other
Mesopen
Coolsculpting
Problem Summary
*
🛈
Description
*
🛈
PHOTOS - You can Upload upto 4 photos
Upload Photo 1
Upload Photo 2
Upload Photo 3
Upload Photo 4
Notify Dr Kanase immediately!