Full Name: Email: Phone Number: Are you pregnant?
If you answered “YES” to any of these questions listed above, please use the blank portion of this form to provide a brief explanation and correlate our answers to the specific question number. A “YES” does not necessarily indicate that you are not an acceptable candidate for permanent cosmetics. It may simply be information that is valuable to me as your technician. Each person’s body is unique and certain health conditions that affect healing may require you to consult with your physician before proceeding. If this form has bot addressed a medical condition you have, please list it and inform your technician. I acknowledge by signing this agreement that I have been given full opportunity to ask any questions I may have and that all of my questions have been answered to my full and total satisfaction. I specifically acknowledge that I have been advise of the facts set forth below and I agree as follows:
Leave this empty:
Your legal name
Signed by Michelle Bernard
Signed On: September 25, 2019
If you have questions about the contents of this document, you can email the document owner.
Document Name: Microblading Form
Agree & Sign