Michelle Jennings, RN., ICS., FAAM www.MichelleJenningsRN.com (727) 410.0452
PERMANENT COSMETICS Consultation Form
Services Requested / Conditions... Select all that apply:
If I have checked Herpes/Cold Sores I am required to consult with my Physician about anti-viral options. I understand that it is my responsibility. An outbreak during healing can disrupt the final result of my procedure.
When you've completed the form you can SUBMIT ONLINE by clicking "SUBMIT" below. Your information will go directly to Michelle Jennings, RN.
You can also complete the form online, then print.