CancerDiabetesHigh Blood PressureHeart ConditionsHIV/AIDSHerpesKeloid ScarringSkin Cancer or Skin Lesions

AllergiesSeizure DisorderArthritisHepatitisHormone ImbalanceThyroid ImbalanceBlood Clotting DisorderRespiratory Disease

Autoimmune DiseaseParkinson’sMyasthenia GravesLambert-Eaton SyndromeMultiple Sclerosis (MS)Amuotrophic Lateral Sclerosis (ALS)Depression/AnxietyHeadaches

Are you pregnant or trying to get pregnant?

Are you breastfeeding?

Are you using contraception?

Do you have tattoos or Permanent Makeup?

Do you regularly sun bathe or use sunless self tanners/tanning beds?

Do you have a history of oral cold sores?

Have you ever had neurotoxin (Botox, Jeuveau, Dysport, etc…) or any dermal fillers?

Any complications?

Is there any history of facial surgery?

Is there any history of trauma to the head or face?

Have you ever experienced an Anaphylasis Shock?

IodineAlcoholHydrocortisoneLidocaine (Anesthetic)Hyaluronic Acid InjectionsFoodEggsSeafood