Bowerman Artistry

Good Faith Exam

Good Faith Exam for Laser Services

The $40 fee for this virtual exam goes directly to the licensed medical provider to administer the required evaluation.

This is required by law in the state of Indiana to have any laser services rendered.

**IMPORTANT PLEASE READ BEFORE PROCEEDING**

Before you take exam, do any of these apply to you?

-Currently taking steroid or antibiotic

-Pregnant or Nursing

-Received Vaccines within the last 2 weeks

-Surgery within the last 10-12 weeks

-Using a self tanner

**IF you answer YES to any of these please contact us before proceeding**

First Name *

Last Name *

Phone *

Email *

Date of birth *

Address

Street Address *

City *

State *

Postal Code *

Before you take exam, do any of these apply to you?
-Currently taking steroid or antibiotic
-Pregnant or Nursing
-Received Vaccines within the last 2 weeks
-Surgery within the last 10-12 weeks
-Using a self tanner
-Using Retinols, Retin-a, or Tretinoins
**IF you answer YES to any of these please contact us before proceeding**

I answer no to all of the above. I understand that the $40 Good Faith Exam fee is non-refundable, even if I do not pass the exam or I am not approved to move forward. By scheduling this appointment, I confirm that I am in generally good health and understand that approval to proceed is based on the information provided during the exam. Final determination is made at the medical provider’s discretion.*

Good Faith Exam *

$ 40

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Serving Mishawaka, South Bend, Elkhart, Granger, Osceola, Niles and the greater Northern Indiana and Southwest Michigan communities with trusted permanent makeup, laser services, facials, lashes and advanced beauty care.