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COMPLIANCE INFO
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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M
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MARCH
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4100 – Safe Body Art
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PR0548695
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COMPLIANCE INFO
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Entry Properties
Last modified
2/7/2024 9:41:30 AM
Creation date
10/17/2023 9:55:27 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0548695
PE
4120
FACILITY_ID
FA0027870
FACILITY_NAME
CHANGES BEAUTE LOUNGE (BARBER, NICOLE)
STREET_NUMBER
211
Direction
E
STREET_NAME
MARCH
STREET_TYPE
LN
City
STOCKTON
Zip
95207
CURRENT_STATUS
01
SITE_LOCATION
211 E MARCH LN
P_LOCATION
01
QC Status
Approved
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SJGOV\cfield
Tags
EHD - Public
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I understand that a retouch procedure will be performed 1-3 months after the initial procedure <br /> and that after a 3-month period I will be charged an additional fee for any further work. I <br /> understand that it is my responsibility to book the appointment at a time convenient for both <br /> parties. <br /> The result of the procedure is determined by the following: Medication,Skin Characteristics- <br /> (dry, oily, sun-damaged and thickness), Natural skin undertones - (blending with chosen <br /> pigment), Personal pH balance of skin, which changes from visit to visit, Alcohol intake and <br /> smoking, adhering to Post Procedure care treatment. <br /> Upon completion of the procedure there may be swelling and redness of the skin,which will <br /> subside between 1-4 days.In some cases bruising may occur.You may resume normal activities <br /> immediately following the procedure however,using cosmetics,excessive perspiration,steamy <br /> showers and exposure of the sun to the affected area should be limited. <br /> I have been advised that the true colour will be seen 1 month after each procedure,and that the <br /> pigment may vary in colour according to skin tones, skin type, age and skin conditions. I <br /> understand that some skins accept pigment more readily than others and no guarantee to an <br /> exact effect or colour can be given. <br /> I give my consent to not publicly (including social media) attack, accuse or humiliate the <br /> provider in case I am not satisfied with the results of procedure. I agree that in case I have <br /> claims or dissatisfactions I will personally contact my provider's office immediately where I <br /> can receive professional resolution of my claims. <br /> I am aware that the lip procedures may stimulate any dormant virus such as herpes (cold <br /> sores). I am informed that eye procedures may stimulate dormant eye disorders or eye <br /> infections,and that some medication can prevent absorption of the pigment. <br /> I agree to follow all pre-procedure and post-procedure instructions as provided and explained <br /> to me by the technician. I confirm that I have received copies of all the relevant aftercare <br /> instructions. <br /> Being of sound mind and body,I hereby release any and all responsibility.I accept any and all <br /> responsibility myself for any consequence that might stem from my decision to have any <br /> permanent cosmetics procedure performed by <br /> For the purpose of documentation, I also consent to the taking of "before" and "after" <br /> photographs of said procedure(s)for record purposes and for use in presentation portfolios. <br /> I certify that I have read and have had explained to me and fully understand the above consent and <br /> procedure permit;that the explanations therein reffered to were made and I accept full resposibility for <br /> these and or other complications which may arise or result during or following the permanent cosmetic/ <br /> tattoo procedures which is to be performed at my request according to this consent and procedure permit <br /> To my knowledge I do not have any physical,mental,or medical impairment or disability that might affect my well <br /> being as a direct or indirect result of my decision to have the procedure done at this time.I am over 18 years of age.I <br /> am not pregnant.I am not under the influence of drugs or alcohol. <br /> I have read an understood the above information. <br /> Client Name/Signature Date <br /> Therapist Name/Signature Date <br />
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