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<br /> SCAR &) STRETCH MARK CAMOFLAUGE TATTOO
<br /> CLIENT INFORMATION
<br /> Name: ...................................................................................................................._...........
<br /> Dateof Birth: Email:................................................................................................................................
<br /> ............................................................................................................
<br /> Must be 18 Years or Older to receive treatment
<br /> Address: City: ................................................... zip Code: ......................................
<br /> Phone:
<br /> Emergency
<br /> ................................_........,..................................,................................................. Contact:
<br /> ..................................................................................................................
<br /> TATTOO DETAILS
<br /> How old are the scars or scretch-marks your tying to get treated ?..................._...................................................................
<br /> Please provide some history on how you got your scar or stretch-marks
<br /> and what your main concern is before starting skin camouflage
<br /> treatments?
<br /> ...................................................................................................................
<br /> _..............................,.,..........................................................................................................,..,.....................................
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<br /> ......................._....................................................................................................................................................................................................................................._......y.........................................................................
<br /> HEALTH INFORMATION
<br /> Do you have any existing tattoos? ❑ Yes ❑ No
<br /> If yes,please describe and specify the location: .............-............................_ ...................................-..... .-..... .,,.... ...-.. .-.........................................
<br /> Do you have any skin conditions or sensitivities that the artist should be aware of? ❑ Yes ❑ No
<br /> Ifyes,please specify: ........................................................................................................................................................
<br /> Have you had any recent surgeries or medical procedures and did they ❑ Yes ❑ No
<br /> require any antibiotics?
<br /> Ifyes,please provide details; ..........................................................................................................................................................................................................................................
<br /> [THE Cl-IAMELEON METHOD ]
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