MEDICAL HISTORY

Hello Beautiful! 
I am so happy to know you're on your way to perfect, effortless brows each and every day!
Please take a few moments to fill out this medical history form so I can be fully prepare to help you achieve #browgoals at your appointment! XOXO - Maris

1. Personal Information *
2. Emergency Contact name and phone number *
3. Do you have or have previously had any of the following: *
4. If you answered yes to ANY of the questions above, please provide a detailed explanation below: *
5. Any other diseases or disorders not listed? *
6. Do you use skin care products containing Retin-A, Glycolic Acid, or Alpha Hydroxyl? *
7. Taking blood thinners such as: Aspirin, Ibuprofen, Alcohol, Coumadin etc? PLEASE LIST *
8. Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylene Glycol, Vitamin E Acetate, etc. PLEASE LIST *
9. Allergies to metals, food, etc? PLEASE LIST *
10. Please list any medications you are taking: *
By singing below, I confirm I have answered all questions accurately to the best of my knowledge *