PRESCRIPTION
Ref: D4U-RX-0418
Date: 6 Oct 2026
Patient
Emma Collins
DOB: 12 Apr 1988 (age 38)
27 Albert Road, Manchester
M14 5QW
07700 900123
Clinic
Lumière Aesthetics — Manchester
Medical conditions / medication
No known allergies. No current medication.
| Rx | Product | Description | Qty |
|---|---|---|---|
| 1 | Botox 100 units | Glabellar lines | 1 |
Derma4U Ltd · www.derma4u.co.uk · This prescription is valid for 28 days from the date of issue.