Full Name
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First Name
Last Name
Phone
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Area Code
Phone Number
Instagram
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Check all the boxes that pertain to you at the time of the submission.
Pregnancy/Breastfeeding
Skin Conditions (Psoriasis, Eczema, Dermatitis, or Rosacea)
Blood Thinning Medications
History of Keloids or Hypertrophic Scarring
Recent Cosmetic Treatments (such as chemical peels, laser resurfacing, Botox injections)
Allergies (to pigments, ingredients in permanent makeup)
Immunosuppression
Unstable Medical Conditions (Diabetes, Hypertension, Autoimmune disorders)
History of reactions to tattoos or permanent makeup
E-mail
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What services are you interested in?
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Lash Extensions
Brow
PMU Lip Blushing
PMU Freckles
What day’s work best for you?
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Monday
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Wednesday
What time works best for you?
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Morning
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Upload headshot photos of bare face- no makeup, no lashes.
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