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Client Intake Form

areola  tattooing micropigmentation re-pigmentation scar camouflage 3D Areola Scar Resurfacing Scar Relaxation jnkless stretchmark revision breast cancer breast micropigmentation 

Please tell us how old are the areas of concern that you would like treated? Please list all separately.

(Ex: Back Scar 4 yrs, Knee Scar 2 yrs, etc.)

Please tell us anything we may need to know about your treatment areas so we may better serve you.

Conceal Touch, Areola Tattoo, Scar Relaxation, Resurfacing, Repigmentation, Inkless Stretchmark, Scar Camouflage

Please upload up to 10 pictures of your area to be treated. Your FULL NAME must be attached to all your photos. Please & Thank you!

(Ex. Jane Doe - right knee)

Select File

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