OC SKin Car Center

Please fill out the following form
in order to participate in our activity.

Have you been hospitalized in the last 12 months?
Are you suffering from a medical condition, illness, or injury?

AGREEMENT: I request and consent to these procedures being carried out today without undergoing a
sensitivity patch test. The sensitivity test, which if conducted may indicate my sensitivity / allergy to the
products. I understand the contents of this form and take full responsibility for my actions, thus absolving all
other parties of their responsibilities, if any, associated with the supply of the products and services(s).

Thanks for submitting!