Caremore theme

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Image FieldThis is a legal document. Please read carefully
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Client Name:* This field is required.
First Name
Last Name
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Birth Date* This field is required.
Date
Month
Day
Year
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Age
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E-mail:
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Phone Number:* This field is required.
Area Code
Phone Number
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Appointment Date
Date
Month
Day
Year
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Address* This field is required.
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ID number* This field is required.
state id.
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Upload Photo ID* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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Upload Photo of Bare Brows* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Natural Brow, NO Makeup added. Important for Coverups over other artist work.
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What are the main concerns relating to your eyebrows? What would you like to improve?
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What is the perfect shape, color, density, and thickness of your perfect brow?
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Concerns
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Are you 18 and older?* This field is required.
Yes
No
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Are you under the influence of drug or alcohol?* This field is required.
Yes
No
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Have you consumed Alcohol in the last 48 hours?* This field is required.
Yes
No
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FEMALE ONLY: Are you pregnant or nursing?* This field is required.
Yes
No
Other
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Do you have a communicable disease? if so describe below* This field is required.FAILURE TO MAKE TECHNICIANS KNOWLEDGEABLE OF ANY BLOOD PATHOGEN TRANSMISSIVE DISEASES IS ILLEGAL AND WILL BE PROSECUTED
Yes
No
Other
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Skin conditions(e.g. rashes, eczema, infection, psoriasis, keloids, freckles, etc.)* This field is required.
If yes, please identify the conditions
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Are you currently taking any medications?* This field is required.
If yes, please list
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Any know allergies?* This field is required.
If yes, please list
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Have you ever had an allergic reaction to any of the following:* This field is required.
n/a
Latex
Vaseline
Hair Dyes
Lidociane
Rubber
Metals
Foods
N/A
N/A if not applicable
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Have you ever had an allergic reaction to any of the following:* This field is required.
Latex
Vaseline
Hair Dyes
Lidociane
Rubber
Metals
Foods
N/A
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Medical History(e.g. Diabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.) * This field is required.
If yes, please identify the conditions
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Have you had a chemical or laser peel in the last six weeks?* This field is required.
Yes
No
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Have you had any alopecia AHA preparations in the last two weeks?* This field is required.
Yes
No
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Do you have any healing problems?* This field is required.
Yes
No
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Do you scar easily?* This field is required.
Yes
No
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Do you bruise or bleed easily?* This field is required.
Yes
No
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Have you ever seriously thought about hurting yourself?* This field is required.
Yes
No
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Have you previously had semi permanent make up done ? If yes, When? Also was it machine or manual?* This field is required.
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Old PMU Brow
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
previous artist work
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There is always a risk that tattoos can heal patchy and a different color from what has been used. this is out of our control and we cannot guarantee any results or how long they will last do you accept this risk ?* This field is required.
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Touch ups may be required we cannot say if you will need extra sessions. Your 6-8 week touch up is required. Are you happy to proceed knowing you may need extra sessions to get your desired result from microblading ?* This field is required.
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Microblading is a way of cosmetic tattooing, intended to be semi-permanent lasting average 12-18 months. On a rare occasion, the pigment may migrate under the skin. Please understand this is a risk which can happen although rare . Do you accept this risk?* This field is required.
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Please check below to confirm you have read and fully understand the following* This field is required.
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PMU Consent* This field is required.
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* This field is required.
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Signature* This field is required.
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Date
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E-mail: * This field is required.
Should be Empty: