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ARE YOU OR COULD YOU BE PREGNANT
YES
NO
ARE YOU CURRENTLY BREASTFEEDING
YES
NO
ARE YOU DIABETIC
YES
NO
ARE YOU ON ANY FORM OF CHEMOTHERAPY
YES
NO
ARE YOU ON ANY FORM OF BLOD THINNERS
YES
NO
ANY YOU ON ANY HEART RELATED MEDICATION
YES
NO
ARE YOU ALLERGIC TO NICKEL
YES
NO
ARE YOU ALLERGIC TO PPD
YES
NO
ARE YOU ON ANY MEDICATION
YES
NO
DO YOU SUFFER FROM ANY ALLERGIES SKIN OR NON-SKIN RELATED
YES
NO
DO YOU SUFFER FROM ANY MEDICAL CONDITIONS
YES
NO
DO YOU SUFFER FROM ANY KELOID SCARING
YES
NO
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