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BEAUTY
&
AESTHETICS
Please fill out the following form.
Currently pregnant or breastfeeding
Known allergies (medications, latex, antiseptics)
Diabetes
Autoimmune disease
Blood disorders / clotting issues
Skin conditions
(eczema, psoriasis, dermatitis)
Heart conditions
Current infection or illness
High blood pressure
Seizures
Asthma
Migraines
Epilepsy
History of keloid scarring
Cold sores (lip blush only)
Skin conditions near treatment area
Previous PMU work
I understand Colour retention varies
I understand Results vary and take time
I understand Touch-ups are required
I understand Fading over time is expected
I confirm that the information provided is accurate
I consent to images/videos being taken for medical records.
I consent to anonymized marketing use of images/videos
I consent to treatment following consultation