Name *

First Name

Last Name

Phone *

(###)

###

####

Birthdate *

MM

DD

YYYY

What service(s) are you interested in booking? *

Microblading

Combo Brows

Powder/Ombre Brows

Lip Blushing

Freckles

Unsure

Contraindications

CANNOT GET PROCEDURE IF ANY OF THESE APPLY TO YOU

Pregnant or nursing

Keloid scar easily

Experience slow healing due to diabetes or auto-immune disease

Transmittable blood disease

Sunburnt face at time of procedure

Active skin irritation in procedure area- acne or eczema

Have been on prescription Accutane within the past year

Under the age of 18

Check the box if any of the following conditions apply to you. If so you may not be eligible for the procedure or you may need a doctors clearance.

Anemia

Epilepsy

Auto-immune disorder

Thyroid/graves disease

Major heart conditions

Transmittable blood disease

Undergoing chemotherapy

History of MRSA

Requirements for Procedure *

Check box to confirm and accept each instruction

No Botox less than 3 weeks prior to procedure

No heavy sun exposure for a week before and 2 weeks after procedure

Do not exercise heavily on the day of to keep blood pressure down

No blood thinning medications 48 hours prior to procedure

No chemical peels 6 weeks before or after procedure

No alcohol or caffeinated drinks 24 hours prior to procedure

Must be off antibiotics for 2 weeks prior to procedure

Exfoliate and moisturize lips every day for 3 days leading to your appointment (lip blushing)

Client Policies *

Check box to confirm and accept each instruction

A $50 deposit is required to book an appointment. The appointment is not confirmed until the deposit and Consultation Form have been recieved.

Deposits are non-refundable, if you need to reschedule your appointment I require 48 hours advance notice otherwise the deposit will be forfeit.

The deposit will come off of the TOUCH-UP appointment. (8-12 weeks after your initial appointment)

A touch-up 8-12 weeks after your initial appointment is typically necessary to build the color and perfect the shape for lasting results

Cash is preferred if possible but venmo is also an available form of payment on the day of the appointment