Browsallured Saline Tattoo Removal Consent Form
Please be advised that I am obligated to perform procedures in strict compliance with all hygiene and health protection measures. This information is confidential and it shall also be handled in that way.
Today's Date
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Year
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Month
Day
Date
Client Name
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First Name
Last Name
Email
*
example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
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Area Code
Phone Number
COVID-19 Client Screening
In order to ensure the health and safety of our staff and clients, please answer the following questions truthfully and to the best of your knowledge. Your responses will be kept confidential.
Which of the following best describes your skin type?
I. Always Burns, Never Tans
II. Always Burns, Sometimes Tans
III. Sometimes Burns, Always Tans
IV. Rarely Burns, Always Tans
V. Brown, Moderately Pigmented Skin
VI. Black skin
Health Questionnaire
Please understand that this treatment is not for everyone. In order to find out if you are fit for this procedure, please answer the following health questions truthfully. BrowsAllured LLC will assume no liability in the event you give false information to obtain the treatment.
Check the box if the following apply to you:
Terms & Conditions
*
Please list any medical conditions, issues, or medications not listed above:
Signature
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