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Pre-Consultation Form
First name
*
Last name
*
Email
*
Phone
*
Multi-line address
Country/Region
*
Address
*
City
*
Zip / Postal code
*
How did you hear about me?
*
Referral from friend or family
Google
Yelp
Instagram
Other
Services interested in
Brows
Lips
Eyeliner
Beauty Mark
Are you currently pregnant or breastfeeding?
Yes
No
Do you have previous permanent make-up?
Yes
No
Do you have any major events, vacations, or activities (e.g., swimming, sun exposure) planned in the next 4-6 weeks?
Yes
No
Do you have any of the following medical conditions?
*
Diabetes
Heart Condition
Autoimmune disorder
Bleeding disorder
Allergies
Skin conditions (eczema, psoriasis, etc)
None
Other
Do you have a history of keloid or hypertrophic scarring?
*
Yes
No
What is your skin type?
*
Dry
Oily
Combination
Sensitive
Normal
Not sure
Upload a photo of your natural brows/lips/eyes in good lighting (no makeup).
*
Upload File
Add up to 3 pictures
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