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CLIENT CONSULTATION FORM
Please fill out the following health declaration form. Submissions are valid up to 24 hours prior to the treatment.
heart condition/stroke
severe circulation disorder
skin disorder
kidney disorder
swelling/oedema/haemophilia
cancer
limitation of body movement/arthritis
prone to scarring
hormone imbalance
claustrophobia
hepatisis
metal plates/pins/piercings
recent scar tissue or operations within the last 6 months
allergies, if yes give details below
respiratory issues
are you pregnant
high/low blood pressure
epilespy
are you applying any topical or oral steriods ie retinals or roaccutane
if you have received a patch test for lash tinting/LVL/lash extentsions did you have an allergic response? please tick if yes
diabetes
I confirm that the information given in this form is true
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