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ESTIMATE OF COST <br /> Name: Date of Service: <br /> Procedure #1: <br /> Estimate of Cost: <br /> One follow up appointment is included at no charge with this <br /> procedure: <br /> o Yes <br /> o No <br /> If the answer above is "no", you will be charged $50.00 for ever <br /> 15 minutes of time. <br /> Estimate of Cost per 15 minutes: <br /> Procedure #2: <br /> Estimate of Cost: <br /> One follow up appointment is included at no charge with this <br /> procedure: <br /> o Yes <br /> o No <br /> If the answer above is "no", you witl be charged $50.00 for ever <br /> 15 minutes of time. <br /> Estimate of Cost per 15 minutes: <br /> Signature of Technician Date Signature of Client Date <br /> The estimation of cost may vary according to how sensitive the <br /> customer is and how the customer's skin takes pigment. THIS <br /> IS JUST AN ESTIMATION, THIS IS NOT A GUARANTEE. <br />