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Do you have any known Allergies
Yes
No
Are you currently taking any medications?
Yes
No
Have you ever had any of the following conditions
Are you currently pregnant or breastfeeding
Yes
No
Do you have a history of cold sores or fever blisters
Yes
No
What is your skin type?
Have you had any previous permanent makeup procedures?
Yes
No
Are you currently using any of the following skin care ingredients
Do you have a history of cosmetic treatments such as Botox, fillers or laser treatments?
Yes
No
Which areas you interested in for permanent makeup?
What style do you prefer
I understand that the results of permanent makeup procedures may vary and that I have been informed of possible risks and aftercare instructions
Yes
No
I consent to having photographs taken before and after the procedure for record-keeping and promotional purposes
Yes
No
I acknowledge that i have read and understand all the information provided in this form, and I have answered all questions truthfully to the best of my knowledge
Yes
No
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