Consultation Request Form

Name*

First NameLast Name
Email*
example@example.com
Birth Date*

MonthDayYear
What is your skin type? (check all that apply)*

DryNormalOily
What service are you looking to book? (check all that apply)*

MicrobladingOmbre ShadingCombination BrowsFrecklesNot sure, but I'm open to suggestions.
Do you have any of the following health or skin concerns - especially in the area being tattooed - that I should be aware of? (Check all that apply)

AcneEczemaPsoriasisMoles/BirthmarksAlopeciaTrichotillomaniaCancerChemotherapyOther
If other, please explain:
Have you previously had your eyebrows Microbladed or tattooed?*

YesNoN/A
Have you previously had Freckles tattooed?*

YesNoN/A
Did Bethany do your previous Microblading or Freckles?*

YesNoN/A
What technique was used? (Brow's only)*

MicrobladingOmbre Shading/Powder BrowsA combination of Microblading and shadingI'm not sureN/A
When was the last time you had your eyebrows Microbladed/tattooed or your Freckles tattooed (including touch ups)?*
MM/YYYY
How many times have your eyebrows been Microbladed/tattooed or Freckles tattooed (including touch ups)?*
Please describe what makes you unhappy about your current brows/previous Microblading/Tattoo/Freckle tattoo.*
What goals would you like to achieve for your brows or freckles with this procedure?*
Please submit clear photos of your current brows or freckle inspiration below. Include photos of your head turned slightly left, one slightly right, and one face on. Please also include a photo of yourself and how you typically fill in your brows with makeup.*

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