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Medical In ation Are you 18 years or older? Yes!No Are you pregnant or nursing? Yes/No Eyeliner only: Do you have glaucoma or other eye disease or d' Yes/No Eyeliner only: Have you ever had any eyetrauma? Yes/No Eyeliner y: Have you had vision as Lasik surgery in the last 3 months? Yes!No Eyeliner only:Are you considering having vision correction procedures in the next 2 ? Yes/No Eyeliner only:Are you prone to eye infections(i.e.,conjunctivitisipink eye)? Yes/No Are youon blood thinning ? Yes./No Do you tape aspirin? Do you smoke? Drink Al ? Are you on Accutane,or haw you taken it within the last year? Yes/No Do you have valve implants? Yes/No Prior to dental procedures,do you receive antibiotictherapy? Yes/No Are you on steroids or antiminflarnmatory medications? Yes/No Have you had a joint replacement or organtransplant?if yes,describe: Yes/No Are you an insuffn diabefic? Yes/No Do you have s'eizures or fainting spells? Yes i No Do you bruise or bleed easiW. Yes I No Do you swelleasily? Yes/No Do you have a healing problem? Yes!No Do you have scarring in the area to be ted? Yes/No Do you use Retin-A, Glycolic Acid,Vitamin C or offm e ts? Yes/ o Have you used a tanning bed in the last 30 days? Yes/No Are you currently tanned in the area(s)to be t Yes/No Are you onLithium? Yes/No Have you ever had a fever blister(cold sore), even if only once? Yes 1 No Do you have hemophilia or oftw dotting disorders? Yes/No Do you have an autoirnmune disorder or are you on immunosuppressants? Yes/No Have you ever hadHepatitis? Please circle: A 8 C Yes!No When were you last tested? Do you have any 'ng nerve damage in the area 1 will be working on? Yes I No Do you have any tattoos'? Yes/No Are any of the colors in your to s)sensitive to to sun or rise up in the sun? Yes/No Do you have a hyperactive thyroid Gravds disease? Yes/No Do you haw T' (Pulling of hair,e )? Yes/No Do you have Alopecia tlni lis(total)or AJopecia )? Yes/No