Name Address (Ship to) 877.PCA.SKIN [ ] Fax pcaskin.com Phone Effective Jan 2, 2017 Daily care products cleanse

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1 Customer # Date Name Address (Ship to) Order Form City, State, Zip 877.PCA.SKIN [ ] Fax pcaskin.com Phone Effective Jan 2, 2017 Daily care products cleanse Size 7 oz $15.50 Facial Wash 1 oz $ oz $15.50 Facial Wash Oily/Problem 1 oz $ oz $15.50 Total Wash Face & Body Cleanser 1 oz $ oz $15.50 Creamy Cleanser 1 oz $ oz $18.50 BPO 5% Cleanser 1 oz $3.50 Blemish Control Bar 3.4 oz $19.50 Dry Skin Relief Bar 3.4 oz $19.50 Pigment Bar 3.4 oz $19.50 Daily care products tone Size 7 oz $17.00 Smoothing Toner 1 oz $ oz $17.50 Nutrient Toner 1 oz $4.75 Daily care products correct Size 7 oz $15.50 Gentle Exfoliant 1 oz $ oz $29.00 Purifying Mask.25 oz $ oz $29.00 Revitalizing Mask.25 oz $ oz $54.00 ExLinea Peptide Smoothing Serum.17 oz $ oz $27.50 Pigment Gel.25 oz $ oz $27.50 Pigment Gel HQ Free.25 oz $ oz $22.50 Acne Gel.25 oz $ oz $13.00 Acne Cream.25 oz $ oz $37.50 C-Quench Antioxidant Serum.17 oz $ oz $41.50 A&C Synergy Serum.17 oz $ oz $44.50 Total Strength Serum.17 oz $ oz $37.00 Hydrating Serum.17 oz $ oz $42.50 Rejuvenating Serum.17 oz $ oz $30.50 Anti-Redness Serum.17 oz $ oz $45.00 Retinol Renewal with RestorAtive Complex.18 oz $ oz $54.50 Intensive Clarity Treatment : 0.5% pure retinol night.07 oz C $ oz $54.50 Intensive Age Refining Treatment : 0.5% pure retinol night.07 oz C $ oz $54.50 Intensive Brightening Treatment: 0.5% pure retinol night.07 oz C $ oz $72.50 Intensive Pigment Eraser exlusively sold through physicians.07 oz $ oz $46.50 C&E Strength.25 oz $ oz $48.50 C&E Strength Max.25 oz $ oz $57.50 Dual Action Redness Relief.17 oz $ oz $42.50 Ideal Complex Revitalizing Eye Gel.125 oz $ oz $42.50 Ideal Complex Restorative Eye Cream.125 oz $ oz $25.00 EyeXcellence.125 oz $ oz $39.50 Perfecting Neck & Décolleté.25 oz $ oz $23.50 CliniCalm 1%.25 oz $4.00 Peptide Lip Therapy.3 oz $ PCA.SKIN( ) Fax Page Total pcaskin.com Page 1 of 6

2 Daily care products hydrate & protect Weightless Protection Broad Spectrum SPF 45 Perfecting Protection Broad Spectrum SPF 30 Protecting Hydrator Broad Spectrum SPF 30 Hydrator Plus Broad Spectrum SPF 30 Active Broad Spectrum SPF 45: Water Resistant Size 2.1 oz $ oz $ oz $ oz $ oz $ oz $ oz $ oz $ oz $ oz $3.50 Sheer Tint Broad Spectrum SPF oz $24.50 Clearskin ReBalance Après Peel Hydrating Balm Collagen Hydrator Silkcoat Balm Body Therapy Daily Care Solutions [Trial-Size] 1.7 oz $ oz $ oz $ oz $ oz $ oz $ oz $ oz $ oz $ oz $ oz $ oz $5.00 The Post-Procedure Solution includes Facial Wash, CliniCalm 1%, Perfecting Protection Broad Spectrum SPF 30, ReBalance, Silkcoat Balm $19.00 The Acne Kit includes BPO 5% Cleanser, Acne Cream, Intensive Clarity Treatment: 0.5% pure retinol night, Weightless Protection Broad Spectrum SPF 45, Clearskin The Anti-Aging Kit includes ExLinea Peptide Smoothing Serum, C&E Strength Max, Intensive Age Refining Treatment : 0.5% pure retinol night, Hydrator Plus Broad Spectrum SPF 30, Collagen Hydrator The Sensitive Skin Kit includes Hydrating Serum, Anti-Redness Serum, Retinol Renewal with RestorAtive Complex, Protecting Hydrator Broad Spectrum SPF 30, ReBalance $20.00 $30.00 $27.50 The Discoloration Kit includes Pigment Gel, C&E Strength Max, Intensive Brightening Treatment: 0.5% pure retinol night, Perfecting Protection Broad Spectrum SPF 30, ReBalance $27.50 The Preventative Kit includes C&E Strength, Rejuvenating Serum, Retinol Renewal with RestorAtive Complex, Protecting Hydrator Broad Spectrum SPF 30, ReBalance $27.50 The Solution for Chemotherapy and Radiation Therapy Support includes Creamy Cleanser, Hydrating Serum, Anti-Redness Serum, Perfecting Protection Broad Spectrum SPF 30, ReBalance, Silkcoat, CliniCalm 1%, Peptide Lip Therapy $41.50 Daily care regimens Size $72.00 The Acne Control Regimen includes BPO 5% Cleanser, Acne Cream, Intensive Clarity Treatment : 0.5% pure retinol night, Clearskin Daily Care Products Back Bar Size (pump included) Facial Wash Facial Wash Oily/Problem Smoothing Toner Nutrient Toner Size 16 oz $ oz $ oz $ oz $50.00 CliniCalm 1% 7 oz $58.00 Weightless Protection Broad Spectrum SPF 45 7 oz $58.00 Perfecting Protection Broad Spectrum SPF 30 Hydrator Plus Broad Spectrum SPF 30 7 oz $ oz $56.00 Clearskin 7 oz $56.00 ReBalance 7 oz $56.00 Page 2 Total

3 Professional Treatments (least to most active) Enhanced Jessner's Treatments PCA Peel Hydroquinone Free PCA Peel with Hydroquinone PCA Peel with Hydroquinone and Resorcinol Size 2 oz $ oz $ oz $ oz $ oz $ oz $ oz $ oz $8.00 Blended TCA Peels Sensi Peel Ultra Peel I Ultra Peel Forte for physicians' use only Smoothing Body Peel Treatment (Steps 1 2) 2 oz $ oz $ oz $ oz $ oz $ oz $ oz $ oz $12.00 full-size $ trial-size $ oz $ oz $ oz $ oz $39.75 Therapeutic Mask Series Professional Treatments (cont.) Therapeutic Mask Treatment (full-size and trial-size) Mask Mini Suite includes: Hydrate Oat Milk Mask.25 oz., Revitalize Papaya Mask.25 oz., Clarify Salicylic Acid Mask.25 oz., Retexturize Pumpkin Mask.25 oz., Calming 4 oz $ oz $ oz $ oz $ oz $ oz $ oz $ oz $3.50 Size full-size $ trial-size $9.75 full-size $ trial-size $9.75 full-size $ trial-size $9.75 full-size $ trial-size $9.75 trial-size $20.25 Balm.25 oz., Replenishing Gel.25 oz. Retinoid Treatments 1.7 oz $ oz $ % Pure Retinol Peel 10 packettes $ Oxygenating Trio (Steps 1 3) Oxygenator (Step 3) Detox Gel Deep Pore Treatment full-size $ trial-size $ oz $ oz $ oz $ oz $ oz $ oz $ oz $ oz $6.00 Treatment Enhancements Replenishing Gel Calming Balm Pre-Peel Accelerator Mask (Step 1) Smoothing Body Peel (Step 2) Hydrate: Therapeutic Oat Milk Mask Revitalize: Therapeutic Papaya Mask Clarify: Therapeutic Salicylic Acid Mask Retexturize: Therapeutic Pumpkin Mask Hydrate: Therapeutic Oat Milk Mask Treatment includes Hydrate Mask, Revitalize: Therapeutic Papaya Mask Treatment includes Revitalize Mask, Clarify: Therapeutic Salicylic Acid Mask Treatment includes Clarify Mask, Retexturize: Therapeutic Pumpkin Mask Treatment includes Retexturize Mask, Advanced Treatment Booster Activator (Step 1) Detoxifier (Step 2) 3.3 oz $ oz $ oz $ oz $3.25 Page 3 of 6 Page 3 Total

4 Professional Treatments [Trial-Size sets] *clear travel bag and protocol included Enhanced Jessner's Peels PCA Peel Treatment Set includes Facial Wash Oily/Problem, Smoothing Toner, PCA Peel with Hydroquinone, Pigment Gel, ReBalance, Perfecting Perfection Broad Spectrum SPF $40.00 Blended TCA Peels Sensi Peel Treatment Set includes Facial Wash Oily/Problem, Smoothing Toner, Sensi Peel, Rejuvenating Serum, ReBalance, Perfecting Protection Broad Spectrum SPF $38.50 Ultra Peel I Treatment Set includes Facial Wash Oily/Problem, Smoothing Toner, Ultra Peel I, ExLinea Peptide Smoothing Serum, ReBalance, Perfecting Protection Broad Spectrum SPF $45.00 Ultra Peel Forte Treatment Set includes Facial Wash Oily/Problem, Smoothing Toner, Ultra Peel Forte, ReBalance, Perfecting Protection Broad Spectrum SPF $34.00 Smoothing Body Peel Treatment Set includes Facial Wash Oily/Problem, Smoothing Toner, Pre-Peel Accelerator Mask (Step 1), Smoothing Body Peel (Step 2), Perfecting Protection Broad Spectrum SPF $68.00 Therapeutic Masks Hydrate: Therapeutic Oat Milk Mask Treatment Set includes Facial Wash Oily/Problem, Smoothing Toner, Hydrate Mask, Replenishing Gel, Calming Balm, ReBalance, Perfecting Protection Broad Spectrum SPF 30 Revitalize: Therapeutic Papaya Mask Treatment Set includes Facial Wash Oily/Problem, Smoothing Toner, Revitalize Mask, Replenishing Gel, Calming Balm, ReBalance, Perfecting Protection Broad Spectrum SPF 30 Clarify: Therapeutic Salicylic Acid Mask Treatment Set includes Facial Wash Oily/Problem, Smoothing Toner, Clarify Mask, Replenishing Gel, Calming Balm, ReBalance, Perfecting Protection Broad Spectrum SPF 30 Retexturize: Therapeutic Pumpkin Mask Treatment Set includes Facial Wash Oily/Problem, Smoothing Toner, Retexturize Mask, Replenishing Gel, Calming Balm, ReBalance, Perfecting Protection Broad Spectrum SPF 30 Peel Alternative Treatments Oxygenating Trio Set includes Facial Wash Oily/Problem, Smoothing Toner, Activator (Step 1), Detoxifier (Step 2), Oxygenator (Step 3), ReBalance, Perfecting Protection Broad Spectrum SPF 30 Detox Gel Set Deep Pore Treatment includes Facial Wash Oily/Problem, Smoothing Toner, Detox Gel Deep Pore Treatment, Acne Gel, A&C Synergy Serum, Clearskin, Perfecting Protection Broad Spectrum SPF 30 Miscellaneous Supplies PCA SKIN Lab Coat - black (available in sizes XS, S, M, L, XL) PCA SKIN Lab Coat - white (available in sizes XS, S, M, L, XL) $ $ $ $ $ $ $ $44.50 Fan Brush - small $7.00 Fan Brush - medium Fan Brush - large Peel Dish Cotton Squares (4x4) (pack of 100) Disposable Headbands (pack of 24) PCA SKIN Fan Pump for 16 oz. Bottle Sponges - Blemish Control, Pigment Control Bar & Dry Skin Relief Bar (pack of 3) Spatula Trial-Size Solution Clear Travel Bag Wood's Lamp White Light Tube for Wood's Lamp $ $ $ $ $ $ $ B $ $ $ $ $15.00 Black Light Tube for Wood's Lamp $16.00 Page 4 of 6 Page 4 Total

5 Marketing Collateral Marketing Package - Full (includes items below) Patient Brochure (set of 25), Before & After Booklet (set of 5), Acrylic Brochure Stand, PCA SKIN Retail Logo Bag - small (set of 25 white w/tissue), "Recommended by The Skin Cancer Foundation" Poster (18"x24"), "What to Expect from a PCA SKIN Peel" Poster (18"x24"), PCA SKIN notecard & envelope (set of 10), Daily Regimen Pad, Treatment Options for Healthy Skin Brochure (set of 25), "What to Expect from a PCA SKIN Peel" Brochure (set of 25) Marketing Package - Select ( includes items below) $66.00 Patient Brochure (set of 25), Before & After Booklet (set of 5), acrylic brochure stand, PCA SKIN Retail Logo Bag - small (set of 25 white w/tissue), "What to Expect from a PCA SKIN Peel Poster" (18"x24"), What to Expect from a PCA SKIN Peel Brochure (set of 25) $45.00 Before & After Booklet PCA SKIN Summer-Friendly Protocols Booklet PCA SKIN Standard Treatment Protocols Booklet Daily Regimen Pad (1 pad of 25 carbon copy sheets) Patient Brochure (Set of 25): Order of $1-$499 Patient Brochure (Set of 25): Order of $500+ Pre & Post-Treatment Brochures (Set of 25) PCA SKIN Retail Logo Bag - small (Set of 25 white with tissue) PCA SKIN Retail Logo Bag - medium (Set of 10 black with tissue) $ $ $ $ $ $ $ $3.60 PCA SKIN Logo Tissue Paper (25 sheets) $1.50 PCA SKIN Product Postcard (set of 25) 10554PCA $3.75 PCA SKIN Notecard & Envelope (set of 10) $2.75 Acrylic Stand w/ Clear Display $40.00 Before & After Flip Chart $50.00 Product Catalogue SPF Trifold Brochure Single Sampler TRI99999 Poster Series What to Expect from a PCA SKIN Peel (Fitz I-VI) 18"x24" POS11000L $10.00 What to Expect from a PCA SKIN Peel (Fitz I-VI) 11"x14" POS11000S $6.00 The Essentials of Skin Health: The Peel (Fitz I-III) 18"x24" POS11004L $10.00 The Essentials of Skin Health: The Peel (Fitz I-III) 11"x14" POS11004S $6.00 The Essentials of Skin Health: The Peel (Fitz IV-VI) 18"x24" POS11005L $10.00 The Essentials of Skin Health: The Peel (Fitz IV-VI) 11"x14" POS11005S $6.00 The Essentials of Skin Health: The Peel (Men) 18"x24" POS11006L $10.00 The Essentials of Skin Health: The Peel (Men) 11"x14" POS11006S $6.00 Treatment Essentials for Age Defense (Fitz I-III) 18"x24" POS11007L $10.00 Treatment Essentials for Age Defense (Fitz I-III) 11"x14" POS11007S $6.00 Treatment Essentials for Acne Control (Fitz I-III) 18"x24" POS11011L $10.00 Treatment Essentials for Acne Control (Fitz I-III) 11"x14" POS11011S $6.00 Treatment Essentials for Acne Control (Fitz IV-VI) 18"x24" POS11012L $10.00 Treatment Essentials for Acne Control (Fitz IV-VI) 11"x14" POS11012S $6.00 Treatment Essentials for Acne Control (Men) 18"x24" POS11013L $10.00 Treatment Essentials for Acne Control (Men) 11"x14" POS11013S $6.00 Treatment Essentials for Achieving Even Pigment (Fitz I-III) 18"x24" POS11009L $10.00 Treatment Essentials for Achieving Even Pigment (Fitz I-III) 11"x14" POS11009S $6.00 Treatment Essentials for Achieving Even Pigment (Fitz IV-VI) 18"x24" POS11010L $10.00 Treatment Essentials for Achieving Even Pigment (Fitz IV-VI) 11"x14" POS11010S $6.00 Poster Series (cont'd) Treatment Essentials for Sensitive Skin (Fitz I-III) 18"X24" POS11014L $10.00 Treatment Essentials for Sensitive Skin (Fitz I-III) 11"X14" POS11014S $6.00 Recommended by The Skin Cancer Foundation 18"X24" POS11016L $10.00 Recommended by The Skin Cancer Foundation 11"X14" POS11016S $6.00 Minimum Effort. Maximum Results. 18"X24" POS10506L $10.00 Page 5 of 6 Page 5 Total

6 Brochure Series What to Expect from a PCA SKIN Peel (Fitz I-VI) (Set of 25 brochures) Treatment Essentials for Age Defense (Fitz I-III) (Set of 25 brochures) Treatment Essentials for Acne Control (Fitz I-III) (Set of 25 brochures) Treatment Essentials for Acne Control (Fitz IV-VI) (Set of 25 brochures) Treatment Essentials for Acne Control (Men) (Set of 25 brochures) Treatment Essentials for Achieving Even Pigment (Fitz I-III) (Set of 25 brochures) Treatment Essentials for Achieving Even Pigment (Fitz IV-VI) (Set of 25 brochures) Treatment Essentials for Sensitive Skin (Fitz I-III) (Set of 25 brochures) Recommended by The Skin Cancer Foundation (Set of 25 brochures) Monthly Promotion TRI $4.50 TRI $4.50 TRI $4.50 TRI $4.50 TRI $4.50 TRI $4.50 TRI $4.50 TRI $4.50 TRI $4.50 Holiday promo: ExLinea Peptide Smoothing Serum, Ideal Complex Restorative Eye Cream and an exlusive PCA SKIN travel bag. 1116A $45.00 Holiday promo: Rejuvenating Serum, Ideal Complex Revitalizing Eye Gel and an exlusive PCA SKIN travel bag. 1116B $45.00 Holiday promo: Hydrating Serum, Ideal Complex Revitalizing Eye Gel and an exclusive PCA SKIN travel bag. 1116C $45.00 Page 6 of 6 Page 6 Total Credit Card Payment CC # Subtotal Exp. Date Estimated Shipping $9.00 echeck Acct Holder Check # Routing # Grand Total Shipping Options (please delete all except your selection) Acct # Overnight 2nd day 3 day Ground Please note: Free shipping applies to single orders over $1,000 (regular ground in the USA). Return policy is 60 days from the date of invoice. Trial-size & monthly promotional products are not returnable. Returned products are subject to a 20% restocking fee. rev LT

new patient procedure checklist q3

new patient procedure checklist q3 Patient name: Date: Clinician comments Discuss peel treatments with patient: q Patient Profile form q Expectations q Possible reactions q Mandatory sunscreen use q Have