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Medical Information <br />Yes No <br />Do you suffer from a medical or skin condition such as: Keloids or <br />hypertrophic scarring, psoriasis (at the procedure site) or any open <br />wounds or lesions? <br />Do you bruise easily, swell or bleed easily? <br />Do you use Retin-A, Glycolic Acid, Vitamin C or other exfoliantes? <br />Do you have autoimmune disorder? <br />Do you have a history of medication use or currently using <br />medications? <br />Do you have Trichoitillomania? (Pulling of hair, eyebrows or <br />lashes?) <br />Do you have any pre-existing nerve damage in the area that I will be <br />working on? <br />Do you have tattoos? <br />Are any of the colors in your tattoo(s) sensitive to sun or rise up in <br />the sun? <br />Are you currently tanned in the area(s) to be treated? <br />Do you tint your eyebrows? Eyelashes? <br />Have you had Botox to raise your eyebrows? <br />Have you had Collagen, Restalyne or Juviderm injected into your <br />lips? <br />Have you had a fat transfer into your lips? <br />Have you ever had an allergic reaction to a topical antibiotic? <br />Have you ever had an allergic reaction to Lidocaine? <br />5 <br />