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f 3j20ad7pg7 <br /> IP ! ODY �E hj� reut v-tl,+ <br /> G E N E S I S l IX <br /> _ Asr r \ 1 \ I R O '3��?.OZ3 <br /> STRETCH MARK/SCAR CAMOUFLAGE TATTOOING Pill- <br /> Thankyou for trusting Body Pegenesis Ilc.with your cosmetic <br /> tattooing services. Please fill out& return the waiver below prior to <br /> your appointment.Thankyou. <br /> Name(required) First Name Last Name <br /> r <br /> Date of birth(required) <br /> Address(required) <br /> City(required) State(required) <br /> Zip code(required) Email(required) <br /> Phone(required) <br /> Valid ID Acknowledgement(required) <br /> I understand that I am required to present a valid US government issued ID at the time of my procedure <br /> Driver's License <br /> Passport <br /> What procedure are you having done today?(required) <br /> Stretch Mark Camouflage Tattoo Scar Camouflage Tattoo <br /> Do you have a history of herpes at the procedure site?(required) <br /> F1 ) I IS <br /> F1 \0 <br /> Do you have a history of allergic reactions to antibiotics?(required) <br /> llti <br /> \t) <br /> Do you have a history of cardiac valve disease?(Required) <br /> 1-1 11ti <br /> Are you currently using medication, including being prescribed antibiotics prior to dental or surgical procedures?(required) <br /> llti <br /> F-1 <br />