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Do you take antibiotics when going to the dentist? YES NO <br /> If yes please <br /> explain: <br /> Are you presently taking any blood thinner medication which thins the blood? YES <br /> NO <br /> Are you taking any other medications including anti-depressants or mood altering <br /> drugs? YES NO <br /> If yes, please list: <br /> Are you pregnant or nursing? YES NO <br /> The above is complete and accurate to my medical history. <br /> CLIENT SIGNATURE: <br /> DATE: <br /> TOUCH-UP DATE: <br /> TOUCH-UP DATE: <br /> TOUCH-UP DATE: <br /> CONSENT TO PERMANENT MAKE-UP APPLICATION, RELEASE AND WAIVER OF <br /> ALL CLAIMS <br /> I acknowledge by signing this release that I have been given the full opportunity to ask <br /> any and all questions which I might have about obtaining permanent make-up from <br /> hereafter called Technician and that all of my questions have <br /> been answered to my full and total satisfaction. I specifically acknowledge that I have <br />