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t <br />To perform the Micro-blading technique in a safe manner, please answer the following health <br />questions truthfully. Pretty Obsessed Boutique will keep all information disclosed in a confidential <br />manner and will use it only for purposes of determining whether treatment is appropriate for <br />client. <br />Do you suffer from the following diseases or are you taking any of these medications? <br />Please circle your answer. <br />Hemophilia/ Bleeding disorders <br />YES <br />NO <br />Diabetes <br />YES <br />NO <br />Hepatitis <br />YES <br />NO <br />HIV + <br />YES <br />NO <br />Skin diseases <br />YES <br />NO <br />Eczema <br />YES <br />NO <br />Autoimmune diseases <br />YES <br />NO <br />Bloodborne pathogen diseases <br />YES <br />NO <br />Herpes at procedure site <br />YES <br />NO <br />