Laserfiche WebLink
r t <br /> kBODY- <br /> 7 ,iIS <br /> S�PETCH MAR, SCAR"A•-0OUFL.AGE TATTOOING <br /> Are you currently under medical care?:(required) Yes No <br /> Have you had any cosmetic injections in the last 3 months?(required) Yes No <br /> Have you had Botox/Dysport or any other fillers in the last 2 weeks?:(required) Yes No <br /> Are you pregnant or breastfeeding?(required) Yes No <br /> Do you have any allergies?(required) Yes No <br /> If yes,please list allergies here. <br /> Are you prone to herpes at procedure site? (required) Yes No <br /> Are you a hemophiliac?(required) Yes No <br /> Do you take fish oil supplements or blood thinners?(required) Yes No <br /> Do you have diabetes?(required) Yes No <br /> Do you have any heart conditions?(required) Yes No <br /> Do you have high or low blood pressure?(required) Yes No <br /> Do you have Hepatitis A,B or C?(required) Yes No <br /> Are you HIV positive?(required) Yes No <br /> Do you have any contagious diseases?(required) Yes No <br /> Do you have any skin conditions?(required) Yes No <br /> Do you have or have you had cancer?(required) Yes No <br /> Have you been under the influence of drugs or alcohol in the last 24 hours? Yes No <br /> (required) <br /> Have you had any caffeine in the last 24 hours?(required) Yes No <br /> Are you currently taking ANY medications? (required) Yes No <br /> If yes,please list here: <br /> Are you currently taking any immunosuppresants?(required) Yes No <br /> If yes,please list here: <br /> Are you taking Acutane?(required) Yes No <br /> Are you currently using Retin-A or rapid exfoliators?(required) Yes No <br /> 2 <br />