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HEALTH QUESTIONNAIRE

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Please answer the following health questions truthfully. We will keep all information disclosed in a confidential manner and will use it only for purposes of determining whether you are an ideal candidate for the brow service procedures.

Have you been in contact with anyone who had COVID or flu like symptoms in the last 14 days? Required
Do you have any of the following symptoms: fever, cough, sore throat Required

Do you suffer from any of the following diseases or disorders?

Hemophilia Required
Allergies Required
Diabetes Mellitus (Diabetes) Required
Autoimmune Disases Required
Heptatitis A, B, C, D, E, F Required
Do you have Herpes? Required
HIV + Required
Infectious Diseases / High Fever Required
Skin Diseases Required
Epilepsy Required
Eczema Required
Cardiovascular Problems Required

Are you taking any of the following medications?

Blood Thinners (Anticoagulants) Required
Are you taking any medications on a daily basis? Required
Do you have a pacemaker? Required
Do you have problems with healing wounds? Required
Have you consumed drugs or alcohol in the last 24 hours? Required
Did you in the last 14 days undergo surgery, in which you were exposed to radiation, or any other medical interventions? Required
Are you pregnant or nursing? Required

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CONTACT 

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CONTACT US

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info@themodernartistryco.com

403.907.0890

lOCATION

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THE BOUJEE BROW STUDIO + ACADEMY

5906 50 STREET

LEDUC, AB T9E 6P1

OPENING HOURS

Mon - Fri :

10am - 6pm

Sat:

11am - 4pm

Sun:

CLOSED

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