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FACIAL CONSENT FORM

Are you currently using or have used any of the following medications or topicals in the past?
Are you currently pregnant?
Have you had sun exposure in the last 24 hours?
Do you have any health concerns that I should be aware of?
Do you have metal implants?
Have you had any laser, microdermabrasion, chemical peel treatments, Botox or injectables within the last 30 days?
Do you have any of the following? Select all that apply.
Do you wear contact lenses?
Do you smoke or vape?
Rate your level of stress from 1 to 4. (1=lowest, 4=highest)

Thanks for submitting!

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