** THIS FORM MUST BE SUBMITTED PRIOR TO APPOINTMENT ARRIVAL **

Health Declaration

Please fill out the following health declaration form in order to receive services provided by Cali Girl Permanent Makeup
Have you been fully vaccinated against COVID-19?
Upload Vaccination Card
Are you experiencing any flu-like or Covid symptoms?
FOR LIP TINT SERVICES: Have you ever had a cold sore? If yes, you must contact your physician prior to lip tint treatment for a Rx for ZOVIRAX capsules, an antibiotic which prevents cold sores.

I have read the above information regarding ZOVIRAX and understand its use is mandatory if I desire lip liner or full lip color procedures.

Do you take antibiotics prior to dental treatment?
Do you suffer from any of the following:
Have you ever gotten a tattoo or permanent makeup service before?
Are you currently taking any blood thinnners (alcohol, fish oil, coffee, aspirin, ibuprofin, prescribed blood thinners)?
Are you pregnant or nursing?
Do you wear contact lenses?

I understand that if I fail to cancel my appointment at least 72 hours prior to my scheduled appointment, I forfeit the deposit paid toward treatment in order to cover my technician's lost time and prepared materials.

All done! Thanks for submitting!