Microblading Intake Form

Client Full Name *

First Name Last Name

Birth Date

Must be 18 years or older (16-17 with parental consent)

Email *

Phone Number *

Address *

Street Address

Mailing Address

City State / Province

Postal / Zip Code Country

How Did You Hear About Meraki Ink?

Instagram Facebook Google Someone Referred Me

What is your availability like? (Please note that weekends and evenings are limited, and there may be a longer wait for them) *

Days, Evenings, or Weekends Evenings or Weekends Only Evenings Only Days Only Shift Work: 7 days on/7 days off Shift work: 14 days on/14 days off

Contact *

I agree to be contacted through email, phone number (text or call) or mailing address

(Optional) Please express any questions or concerns regarding microblading.

Below is the first page of the microblading waiver with a list of the possible contraindications.

Please read each carefully, and write in the box below all that are a "YES", and any medications you are on.

Please list any answers that are a “YES” , as well as any medications you are on:

Please upload clear, well-lit pictures of your eyebrows without makeup.

Browse Files

What you need to know!

Booking/ Deposit

-Bookings will only be completed when both the Microblading Intake Form and the $100 deposit payment are recieved. You will then be added to the wait list.

- The deposit is non-refundable, and will come off of the total at the end of your microblading session.

-The deposit is used as a cancellation fee if less than 48 hours notice is given to reschedule.

Pricing/ Quotes

**APPOINTMENT ONLY**

Microblading: $500 + HST
Microblading Touch Up: Free when booked 4-10 weeks after appointment

Colour Boosts Appointments (1 appointment, no touch up)
Service Price
1-6 Months - $250 + HST
6-12 Months - $300 + HST
12-18 Months - $350 + HST
18-24 Months - $400 + HST

After 24 months, it is full price and a full session again.

Payments for deposits can be made by:

Email transfer: chelsie_aniceto@hotmail.com

Credit Card: Click "Pay Deposit" below in the Credit Card Info section, or add "Deposit" to your cart in the online store, checking out, and completing your payment.

Cash: If you would like to arrange a cash payment for the deposit, please text Chelsie at 1-807-728-2828.

Gift Certificate: You can use a gift certificate as a deposit- please add the # down below.

**This form provides a summary of information and policies, please visit https://merakiink.square.site/pricing to read the extended form.

*

I have read the privacy policy and pricing terms at https://merakiink.square.site/pricing

(Optional) Additional questions or comments:

I understand and agree to all of the above. Signature *

Clear

Payment

I will pay the $100 deposit by: *

Email Transfer Online Store Credit Card Cash Gift Certificate (add number below)

(Optional) Pay Deposit with Credit Card

Pay Deposit $ 100.00 CAD

Enter coupon

Total $ 0.00 CAD