Plasma Concepts Before and After Photo Submission Please enable JavaScript in your browser to complete this form.Your Name: *We will add your name and credit your photoDevice Used: *GenesisRevelation MDOtherTime interval between the two photos: *Number of treatments: *Has this patient received any other combination therapies? *YesNoUnsurePlease list other therapies used:Did patient provide consent? *YesNot yetPatient must have consented to the submitting practitionerUpload Proof of Customer Consent: Click or drag a file to this area to upload. Upload before and after photo: * Click or drag files to this area to upload. You can upload up to 3 files. NameSubmit