Pre-Consultation
This is to ensure both of our safety and your brows to have the best results✨
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Over the age of 18
Yes
No
What service are you interested in?
Microblading
Powder brow
Combo brow
Lip Blush
Do you have any of the following conditions?
Diabetes
History of keloids on the face
On blood thinners
capillaries on or near eyebrows
any severe skin rashes or diseases
none of the above
Any previous Permanent Makeup?
Yes
No
If yes to the previous question how long ago
A couple months ago
1-2 years
3-4 years
5-10 years or longer
never had your brows/lips tattooed
are you pregnant or nursing?
Yes
No
Any medical conditions?
Any condition that causes excessive bleeding
History of Herpes of cold sores (on lips)
infection diseases
pace maker
hepatitis
HIV
None of these
Have you had any of these services?
Botox (past 3 weeks)
Undergoing radiation
chemical peel (past month)
any facial changes(past month)
Lip filler
none of the above
Do you have any covid symptoms? Or have you been exposed to any one with covid 19?
Any questions? DM me on Instagram @beautybybrandirose or text me 909-301-1575
K.!!!.!! No. J. Hds x
Any questions? DM me on Instagram @beautybybrandirose or text me 909-301-1575
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