Please fill out the following Statement of Responsibility form if you have an appointment scheduled at THE BOX by Carolina Mazzoni.

!NOTE: This form does not expire, but it is your responsibility and obligation to complete it and keep it updated. If you have recently undergone cosmetic, dermatological, or dental treatments, consult your doctor and fill out the form again. Examples: Hyaluronic Acid, Botox, Vitamins, Thread Lifts, skin treatments, acne, tooth extractions, etc.

Thank you so much!