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Product Report
 

Please use this form to report any observations, concerns or questions you have about our products. We want to help you and also alert you that there are counterfeit products and false claims made rarely. You can attach photos to this report at the bottom. Thank you for your cooperation.

  * Fields are mandatory
  Today's Date --
   
  *
     
  Name & Surname
  Email
  Cell contact nr
  Landline Contact nr
     
  * Address:
     
  Street Address
  Address Line 2
  City
  Province
  Postal Code
     
  * Product Type:
     
  Pigments
  Pain Control
  Equipment
  Other
   
  * PROCEDURE:
     
  Eyebrows
  Eyeliner
  Lipcolors
  Areola
  Corrective/Camouflage
   
  * Product Name and Brand
 
   
  * Batch# or Serial # of Product
 
   
  * Description of Observation
   
 
   
  * Client Previous Tattoo History
     
  Body
  Cosmetic Tattoo
   
  * Client History: Detailed - Age, Medications, Allergies, Skin and Health History, Does the client spend time outdoors, suntanning booths, "sun worshiper" or any anti-aging products that can accelerate color changes of pigments to pink or orange or purple or gray or blue or green? Please describe in detail.
   
 
   
  * Procedure Information: Timeline - List all Procedures, Dates and Products, including Pigments used on this client.
   
 
   
  * Your Comments Here - What have you done to address any concerns you have?
   
 
   
  * Attach Photo Here.
 
   
  * Attach Photo Here.
 
   
  Attach Photo Here.
 
   
  Attach Photo Here.
 
   
  Attach Photo Here.
 
   
  Attach Photo Here.