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CLIENT INFORMATION SHEET
May we contact you at these numbers if neccesary?
Procedures Desiredpick more than 1 or specify in OTHER which procedures you desire
Have you ever had a cold sore?

You must contact your physician for a presciption of ZOVIRAX capsules, an antibiotic which prevents cold sores.
I have ready the information above and understand the use of ZORIVAX as mandatory if I desire lipline or full lip color procedures.

Are you currently under the care of a physicianselect one answer please
Do you take antibiotics when going to the dentist?select one answer
Do you suffer from
Are you presently taking any medictaion which thins the blood?
Are you taking other medications?
Are you pregnant or nursing?
Do you wear contact lenses?
I have reviewed the prerequisites and agree with the procedures.
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