APPLICATION FOR CONSIDERATION FOR A FREE MICROPIGMENTATION TREATMENT

Are you applying for yourself or someone else?

If someone else, have they given you permission?

Are you (or the person you are applying for) over the age of 18?

Have you ever had Semi/Permanent Makeup before?

Have you ever had Semi/Permanent Makeup to the area you would like treated?

Do you have any scar tissue in or around the area you would like treated?

Do you have any medical conditions?

Are you taking any medications?

Have you had surgery within the last 6 months?

Do you have any mobility issues?

Do you smoke?

Are you able to attend a NO OBLIGATION FREE CONSULTATION at India Gabrielle’s clinic in Bexhill?

Are you able to attend Monday to Friday?

Do you have active cold sores or warts? You must inform India Gabrielle in advance of treatment if you have any history of herpes simplex. It does not mean that you can not have treatment - just that you need to be given the relevant advice to help prevent an outbreak.

Do you use Retin A/Retinova/Retinol products?

Do you have open wounds, or recent scars?

Do you have any skin conditions such as psoriasis, eczema, dermatitis, lichen planus, inflammatory rosacea in area to be treated, severe acne, frequent rashes or any other skin conditions, infection or reactions?

Do you have sunburn, or recent moderate to heavy tanning?

Do you have excessively sensitive skin?

Do you have a history of allergies?

Do you have any known sensitivities to any of the components of this treatment (Including metals)?

Have you taken Roaccutane or any Corticosteroids within the past year?

Have you been treated with chemotherapy or radiation therapy?

Do you have Keloid Scarring?

Do you have an auto immune disorder?

Are you pregnant or breast feeding?

Are you currently suffering from any current illness?

Have you had any injectable treatments such as Botulism or Hyaluronic Acid based semi permanent fillers within the last 6 weeks?

Do you have permanent fillers (those with permanent fillers should not be treated in the area where present)?

Confirmation