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Makeup Intake Form

Please read each statement, initial in each box and sign this document to accept your acknowledgement and agreement of the following:

I affirm that I am 18 years of age or older, and competent to sign this release on my own behalf. I have read and fully understand this agreement and all information detailed above. I understand the service and accept the risks. All of my questions have been answered to my satisfaction and I consent to the terms of this agreement. I do not hold the aesthetician, Kate Aglaia Aesthetics, responsible for any of my conditions that weren’t disclosed at the time of the skin care service, which may be affected by the treatment performed. I understand that this agreement will remain in effect for this procedure and all future procedures conducted by my technician. Although it is impossible to list every potential risk and complication, I have been informed of possible risks and complications. I have also, to the best of my knowledge, given an accurate account of my medical history, including known allergies or prescription drugs or products I am currently ingesting or using topically. The nature and purpose of the products to be used in this service has been explained to me, along with the risks and hazards involved. 

Have you used any of the following in the last 48 hours?:
Check all the following that apply:
Do you participate in vigorous aerobic activity or sports?:
Have you received Botox, Restylane, or Collagen injections in the last 6 months?:
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