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Are you over 18 years of age?
Do you take aspirin or blood thinners regularly?
Have you had injectables in the past 30 days?
Have you taken any mood altering drugs in the past 8 hours?
Do you have a history of cold sores, herpes or fever blisters?
Are you sensitive to Latex?
Have you had a chemical or LASER peel?
Do you have trouble healing?
Have you had any botox or fillers?
Are you currently undergoing radiation or chemotherapy?
Are you currently using Retin-A, AHA, or other exfoliating skin care products?
Are you allergic to any metals?
Are you currently taking anti-inflammatory medications or steroids?
Are you allergic to any anesthetics, (any of the “caines”)?
Do you have a history of skin disease?
Do you have a history of skin sensitivity?
Are you currently taking vitamin A or E in any form?
Are you pregnant or nursing?
Are you currently being treated by a dermatologist?
Please circle any that apply to you:

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