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Li-FT® MEDICAL HEALTH FORM

Are you pregnant or nursing?
Have you had any alcohol in the last 24 hours?
Have you ever had cold sores or fever blisters?
Do you have any allergies to latex?
Have you had a laser or chemical peel within 6 months?
Have you ever had any permanent cosmetics or tattoos applied?
Do you bruise easily for no obvious reason?
Do you routinely use Retin-A, glycolic, or other exfoliating products?
Do you wear contact lenses?
Are you allergic or sensitive to any metals, for instance metals used for jewelry?
Do you have any problems healing?
Is your skin oily?
Do you use tobacco? If you use tobacco you may heal slower and this affects the timing on scheduling a touchup appointment, if applicable.
Do you have any heart conditions?
Are you diabetic? If so, Type 1 or Type 2?
Do you have any autoimmune disorders?
Are you sensitive or allergic to hand creams or body lotions?
Do you have your lips injected with filler materials?
Do you have botox injections?
Do you hyper-pigment? (Tendency to develop dark spots on the skin from wounds or sun)?
Do you tend to develop keloid or hypertrophy scars?
Do you tend to develop keloid or hypertrophy scars?
Do you have any seizure related conditions?
Do you tend to faint or become dizzy?
Do you bleed excessively from minor cuts?
Do you have prosthetic implants?
Do you have prosthetic implants?
Do you consume aspirin daily?
Are you under treatment for depression?
Do you have any type of herpes?
Are you sensitive to petroleum-based products?
If you have permanent cosmetics or tattoos, did you have any problems with healing after they were applied?
Are you undergoing radiation or chemo-therapy treatment?
Are you now, or have you ever
Are you wearing a pacemaker?
Do you take prescription drugs?
Are you anemic?
Do you have a history of skin sensitivities?
Do you have any medical condition that has resulted in a medical professional requiring you to pre-medicate with an antibiotic prior to a dental or other invasive procedure?
Do you have allergies to makeup?
Do you have dry eyes?
Do you intentionally tan – Direct sun or tanning bed?
Do you personally have any history of cancer?
Do you have a history of stroke or heart attack?
To your knowledge are you allergic or resistant to over the counter level numbing products such as ELA-Max?
Are you allergic to hair dyes?
Do you have glaucoma or any other eye disease?
Do you have arthritis?
Do you have high or low blood pressure?
Do you have sinus problems?
Have you experienced Hepatitis or Jaundice during the past 12 months?

Thanks for submitting!