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Lip Blushing Intake Health History

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Lip Blushing Intake Health History

Fill out this form prior to your appointment

Page 1

Personal Information

Email*

Full Name*

Date of Birth*

Phone Number*

Address*

City*

State*

Zip Code*

Emergency Contact Name*

10.

Emergency Contact Phone Number*

Description:Fill out this Lip Blushing Intake & Health History form prior to your appointment.

Get ready for your lip blushing appointment by filling out this Lip Blushing Intake & Health History form. This form will ask you about your medical history, allergies, and current medications to ensure that you are a good candidate for the procedure and to avoid any potential complications. The form will also ask about your desired lip color and shape to ensure that your expectations are met. By filling out this form prior to your appointment, you can save time and ensure that your appointment runs smoothly. Our team will review your form and contact you if any additional information is needed. We look forward to helping you achieve your desired lip look!

Full Name*

Date of Birth*

Phone Number*

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