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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
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
Submit
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