Pre-Qualifying Questions
(These quick questions just help us understand you better for our call tomorrow!)

Are you currently pregnant or nursing?

Yes

N0

Are you currently undergoing treatments such as chemo, radiation, or Accutane?

Yes

No

Are you diabetic? If yes, is it Type 1 or Type 2, and is it controlled?

Yes

No

Do you take any blood thinners, vitamin E, or fish oil?

Yes

No

Are you prone to keloids or do you have any autoimmune disorders?

Yes

No

Have you recently had Botox or fillers?

Yes

No

Are you currently taking antibiotics or steroids?

Yes

No

Is there anything about your health or skin that you think we should be aware of before our call tomorrow?

First Name

Last Name

Phone *

Email *

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