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O Asthma O Eye problems <br /> O Liver/Kdney O Pregnant/Nursing <br /> O Fever Blister <br /> Skin <br /> O Skin Cancer O Motes <br /> DRosacea O Scars <br /> O Acne O Utitigo <br /> 0 Do you heal normally? O Retin-A or Accutane <br /> O Chemical Peels O Allergies to Makeup <br /> O Plastic Surgery O Birthmarks <br /> O Cosmetic Surgery O Hyperpigmentation <br /> Q Hypopigmentation <br /> Medications <br /> (D None O Vitamins/Herbs <br /> O Chemotherapy O Aspirin <br /> O Benadrylor AUegra Q Ibuprofen <br /> 0 Hormones 0 Heart Pills <br /> Q Pain Pills Q Tranquilizers <br /> Q Anti-Depressants Q Blood Thinners <br /> 0 Thyroid Medication O Insulin(diabetes) <br /> 0 Fever Blister <br /> Allergies <br /> O None 0 PeniciWn/Sulfa <br /> O Nickel Q Hair coloring <br /> Q Codeine or Demerol Q Bee sting/insect bite <br /> Q Makeup/Mascara/etc. Q Sunscreens with PABA Pills <br /> E) Pain Pills 0 Anti-Depressants <br /> E) Thyroid Medication Q Fever Blister <br /> Q Other <br /> Please Explain... <br /> Have you taken medication today? <br /> O Yes p No <br /> Do you have tattoos? <br /> Q Yes Q No <br /> Any prior collagen induction? <br />