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** 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
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.

FOR LIP SERVICES ONLY

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:
Are you currently taking any blood thinnners (alcohol, fish oil, coffee, aspirin, ibuprofin, prescribed blood thinners)?
Are you pregnant or nursing?
Have you ever gotten a tattoo or permanent makeup service before?
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.

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All done! Thanks for submitting!

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