Consultation Request Form

Name

First NameLast Name

Email

example@example.com

Birth Date

MonthDayYear

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

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

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)

If other, please explain:

Have you previously had your eyebrows Microbladed or tattooed?

FRECKLE INQUIRES ONLY - Have you previously had Freckles tattooed?

Did Bethany do your previous Microblading or Brow Tattoo?

What technique was used?

When was the last time you had your eyebrows Microbladed/tattooed (including touch ups)?

MM/YYYY

How many times have your eyebrows been Microbladed/tattooed (including touch ups)?

Please describe what makes you unhappy about your current brows/previous Microblading/Brow Tattoo.

What goals would you like to achieve for your brows with this procedure?

Please submit clear photos of your current brows. 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.