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23 IF YES,EXPLAIN 1. Keloid Yes No Location: 4. Diabetes Yes No 5. Alcoholic Yes No 6. Epilepsy Yes No 7. Under 18 yrs.Old Yes No If yes,the client must wait until at least 18 years of age to have permanent makeup,with the exception of areola procedures with a doctor's note and parental permission(See California AB300 Article 2, 119302 d) 8. Using Accutane Yes No 9. Using Retin-A Yes No io. Hemophiliac or other bleeding disorder Yes No 11. Pregnant or nursing Yes No If yes,then you are cannot receive permanent makeup at this time. 12. Active Skin Disease Yes No 13. Autoimmune Disorders Yes No 14. Hepatitis Yes No 15. Blood Disease Yes No 16. Cold Sores Yes No 17. Herpes Yes No 18. Cancer Yes No 19. Tuberculosis Yes No 20. Steroids Yes No This document is Copyright protected by Soffap8 Inc. It may not be reproduced without the expressed written permission of Soffap@ Inc. Call 925 248-6301 or write to 550 N.Canyons Parkway,Livermore,CA 94551. All rights reserved. C Copyright,2014 Soffap@ Inc. Seek legal advice before using this document.