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BODY <br /> R E G E N E S I S <br /> STRETCH MARK/SCAR CAMOUFLAGE TATTOOING <br /> How would you describe your skin?(required) <br /> Dry <br /> Oily <br /> Combination <br /> Unsure <br /> Do you have,or are you prone to...(required) <br /> Acne <br /> Rosacea <br /> Hyperpigmentation <br /> None of these <br /> Are you prone to or do you currently have...(required) <br /> Scar Tissue <br /> Keloid <br /> Concave Scarring <br /> Prior permanent cosmetics <br /> None of these <br /> Is there any other information you feel you should provide to your technician;any other issues you wish to <br /> discuss or address prior to your procedure? <br /> RISKS AND HAZARDS ACKNOWLEDGEMENT(required) <br /> Please check each box to indicate that you have read through it and understand it completely. <br /> I understand makeup is a form of permanent tattoo that requires implantation of pigment through my skin using a <br /> needle. <br /> I understand the risks and hazards related to the performance of this procedure which may include, but are not <br /> limited to:infection,allergic reaction to pigment and/or other products used,dizziness,bleeding,bruising,swelling, <br /> scarring,difficulties in detecting melanoma,fading and fanning/spreading and/or pigment migration. <br /> I understand that it is my responsibility to advise my technician of any questions or concerns I have prior to the start <br /> of my procedure,even if I have not included them here in this form. <br /> I understand there is a no refund policy,and no warranty or guarantee has been made to me as a result of this <br /> procedure. <br /> F1Although my technician will do their best to assure I am happy with the result,the final result cannot be guaranteed. <br /> 3 <br />