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Skin Concerns
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Area(s) of concern
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History of skin cancer?
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Bleeding disorders?
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History of Melasma
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Prone to cold sores?
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Prone to keloids?
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Current use of blood thinners?
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Accutane use in last 6 months?
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Permanent makeup?
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Skin Type
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Pre-treatment protocol prescribed
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Treatments Recommended
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Additional notes:
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Pre-treatment instructions reviewed
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Post-treatment expectation/instructions reviewed
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Other recommended treatments:
• • •
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