(951) 635-6304

Facebook Instagram
General Consent and Basic Questions

General Consent and Basic Questions

Please Read each and Click to check that you fully understand.

First
Last
Referred by (if any)
Referred by (if any)
First
Last
Address
Address
City
State/Province
Zip/Postal
Are you over 18 years of age?
Have you taken aspirin or blood thinners in the past 7 days??
Have you taken any mood altering drugs in the past 8 hours??
Do you have a history of cold sores, herpes, or fever blisters??
Are you sensitive to Latex?
Have you had a chemical or LASER peel? If so when
Do you have trouble healing?
Are you currently undergoing radiation or chemotherapy?
Are you currently using Retin-A, AHA, or other exfoliating skin care products?
Are you allergic to any metals?
Are you currently taking anti-inflammatory medications or steroids?
Are you allergic to any anesthetics, (any of the "caines")?
Do you have a history of skin disease?
Do you have a history of skin sensitivity?
Are you currently taking Vitamin A or E in any form?
Are you pregnant and/or nursing?
Are you currently being treated by a dermatologist?
Click any that may apply
Click any that may apply
Click any that may apply

This error message is only visible to WordPress admins
Error: Connected account for the user shapeitupcontouring does not have permission to use this feed type.

Murrieta Body Contouring
(951) 635-6304

Copyright © 2024 Shape It Up Contouring. All rights reserved.
Website developed by CP Communications

Scroll to Top