ProCell Michrochanneling

ProCell Microchanneling Waiver
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YesNo
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YesNo
Heart condtionHyper pigmentAllergic to steelHepatitisSmokerDiabetes-uncontrolledHIV/AIDSCompromised immunityChronic skin diseaseCold soresAccutane in last 2 yearsHemophilia
I consent (to the best of my knowledge) that the answers I have given are correct and that I have not withheld any information that may be relevant to my treatment.
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ProCell Microchanneling Waiver