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MICROPIGMENTATION/PERMANENT COSMETICS CLIENT INFORMED CONSENT & PROCEDURE CHART NAME: BIRTH DATE: ADDRESS: CITY: STATE: ZIP: HM#: CELL#: EMAIL: PROCEDURE BEING REQUESTED: (Please circle all that apply)
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Micropigmentationpermanent cosmetics - client involves the application of pigments to enhance facial features.
Anyone providing micropigmentationpermanent cosmetics services to clients must file this form.
The form for micropigmentationpermanent cosmetics - client can be filled out online or submitted in person.
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Information such as client details, procedure details, and any potential complications must be reported on this form.
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