Microblading/Ombre Treatment Form

1
Name* This field is required.
First Name
Last Name
2
E-mail Address* This field is required.
3
Mobile Phone Number* This field is required.
4
Landline Phone Number (if applicable)
5
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
6
Occupation
7
Date of Birth* This field is required.
8
Please read these statements carefully - Permanent cosmetics are a form of tattooing. - Re touch procedures may be required. - A healing period of 4 to 6 weeks is required before any touch-up procedure can be performed. - On rare occasions the pigment may migrate under the skin. - Application of permanent cosmetics can be uncomfortable. - The pigments will fade. - Immediately after the procedure, the pigment can be 30 to 50% darker than the desired result. - There may be immediate or delayed allergic reaction to pigments. However, allergic reactions are extremely rare. - A negative allergy test result will not guarantee that you will not have an allergic reaction. - Infections can occur if aftercare is not followed. - Allergic reactions to anaesthetics can occur. - There may be swelling and redness following the procedure. - You may experience minor bleeding. - If you have a MRI scan within 3 months your permanent cosmetics procedure we recommend that you discuss this with your doctor. This information is not intended to alarm you. However, it is imperative that you are informed of the risks involved.* This field is required.
I have read and understand the above statement
9
Close up front view of both brows* This field is required.
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10
Close up of right brow* This field is required.
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11
Close up of left brow* This field is required.
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12
Full facial to show the shape of your face* This field is required.
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13
Please select the option the best describes the microblading treatment required* This field is required.
Fully Reconstruct
Define Existing Brows
Make Existing Brow Bigger
Other
14
Name of Doctor
15
Surgery Name* This field is required.
16
Surgery Phone Number* This field is required.
17
Surgery Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
18
Please list all the medication taken within the last 6 months
19
Have you taken any of the following in the last 48 hours?* This field is required.
Yes
No
Aspirin
Row 0, Column 0
Row 0, Column 1
Ibuprofen
Row 1, Column 0
Row 1, Column 1
Coumandin
Row 2, Column 0
Row 2, Column 1
Alcohol
Row 3, Column 0
Row 3, Column 1
Aspirin
Ibuprofen
Coumandin
Alcohol
Yes
Row 0, Column 0
No
Row 0, Column 1
Yes
Row 1, Column 0
No
Row 1, Column 1
Yes
Row 2, Column 0
No
Row 2, Column 1
Yes
Row 3, Column 0
No
Row 3, Column 1
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20
Have you ever had an allergic reaction to any of the following:* This field is required.
Yes
No
Anaesthetics
Row 0, Column 0
Row 0, Column 1
Adrenaline
Row 1, Column 0
Row 1, Column 1
Latex Rubber
Row 2, Column 0
Row 2, Column 1
Vaseline
Row 3, Column 0
Row 3, Column 1
Crayons
Row 4, Column 0
Row 4, Column 1
Metals
Row 5, Column 0
Row 5, Column 1
Drugs
Row 6, Column 0
Row 6, Column 1
Paints
Row 7, Column 0
Row 7, Column 1
Lanolin
Row 8, Column 0
Row 8, Column 1
Foods
Row 9, Column 0
Row 9, Column 1
Medication
Row 10, Column 0
Row 10, Column 1
Glycerine
Row 11, Column 0
Row 11, Column 1
Lidocaine
Row 12, Column 0
Row 12, Column 1
Another allergy not listed
Row 13, Column 0
Row 13, Column 1
Anaesthetics
Adrenaline
Latex Rubber
Vaseline
Crayons
Metals
Drugs
Paints
Lanolin
Foods
Medication
Glycerine
Lidocaine
Another allergy not listed
Yes
Row 0, Column 0
No
Row 0, Column 1
Yes
Row 1, Column 0
No
Row 1, Column 1
Yes
Row 2, Column 0
No
Row 2, Column 1
Yes
Row 3, Column 0
No
Row 3, Column 1
Yes
Row 4, Column 0
No
Row 4, Column 1
Yes
Row 5, Column 0
No
Row 5, Column 1
Yes
Row 6, Column 0
No
Row 6, Column 1
Yes
Row 7, Column 0
No
Row 7, Column 1
Yes
Row 8, Column 0
No
Row 8, Column 1
Yes
Row 9, Column 0
No
Row 9, Column 1
Yes
Row 10, Column 0
No
Row 10, Column 1
Yes
Row 11, Column 0
No
Row 11, Column 1
Yes
Row 12, Column 0
No
Row 12, Column 1
Yes
Row 13, Column 0
No
Row 13, Column 1
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21
If 'yes' or 'another allergy' please provide additional information below
22
Have you received chemotherapy or radiation treatment in the last year?* This field is required.
Yes
No
23
Please select yes to the following that apply to you;* This field is required.
Yes
No
Abnormal Heart Condition
Row 0, Column 0
Row 0, Column 1
Cold Sores (herpes simplex)
Row 1, Column 0
Row 1, Column 1
Mitral Valve Prolapse
Row 2, Column 0
Row 2, Column 1
Heart Murmur
Row 3, Column 0
Row 3, Column 1
Rheumatic Fever
Row 4, Column 0
Row 4, Column 1
Pacemaker
Row 5, Column 0
Row 5, Column 1
Artificial Heart Valves
Row 6, Column 0
Row 6, Column 1
Anaemia
Row 7, Column 0
Row 7, Column 1
Haemophilia
Row 8, Column 0
Row 8, Column 1
Prolonged Bleeding
Row 9, Column 0
Row 9, Column 1
High Blood Pressure
Row 10, Column 0
Row 10, Column 1
Low Blood Pressure
Row 11, Column 0
Row 11, Column 1
Circulatory Problems
Row 12, Column 0
Row 12, Column 1
Diabetes
Row 13, Column 0
Row 13, Column 1
Epilepsy
Row 14, Column 0
Row 14, Column 1
Fainting Spells or Dizziness
Row 15, Column 0
Row 15, Column 1
Thyroid Disturbances
Row 16, Column 0
Row 16, Column 1
Liver Disease
Row 17, Column 0
Row 17, Column 1
Kidney Disease
Row 18, Column 0
Row 18, Column 1
Glaucoma
Row 19, Column 0
Row 19, Column 1
Stomach Ulcers
Row 20, Column 0
Row 20, Column 1
Tumours, Growths or Cysts
Row 21, Column 0
Row 21, Column 1
Cancer
Row 22, Column 0
Row 22, Column 1
Tuberculosis
Row 23, Column 0
Row 23, Column 1
Stroke
Row 24, Column 0
Row 24, Column 1
HIV
Row 25, Column 0
Row 25, Column 1
Prosthetic Hip or Joint
Row 26, Column 0
Row 26, Column 1
Palpitations
Row 27, Column 0
Row 27, Column 1
Hepatitis
Row 28, Column 0
Row 28, Column 1
Cataracts
Row 29, Column 0
Row 29, Column 1
Blurred Vision
Row 30, Column 0
Row 30, Column 1
Dry Eyes
Row 31, Column 0
Row 31, Column 1
Eye Infection present
Row 32, Column 0
Row 32, Column 1
Alopecia
Row 33, Column 0
Row 33, Column 1
Recent Hair Loss
Row 34, Column 0
Row 34, Column 1
Watery Eyes
Row 35, Column 0
Row 35, Column 1
Contact Lenses
Row 36, Column 0
Row 36, Column 1
Eyelid Surgery
Row 37, Column 0
Row 37, Column 1
Chapped Lips
Row 38, Column 0
Row 38, Column 1
Trichollomania
Row 39, Column 0
Row 39, Column 1
Gore-Tex Implants/Silicone Injections
Row 40, Column 0
Row 40, Column 1
Fat Transfer Injections
Row 41, Column 0
Row 41, Column 1
Botox Injections
Row 42, Column 0
Row 42, Column 1
Collagen Injections
Row 43, Column 0
Row 43, Column 1
Hypertrophic Scars
Row 44, Column 0
Row 44, Column 1
Keloid Scars
Row 45, Column 0
Row 45, Column 1
Scar Easily
Row 46, Column 0
Row 46, Column 1
Healing Problems
Row 47, Column 0
Row 47, Column 1
Bruise or Bleed Easily
Row 48, Column 0
Row 48, Column 1
Sensitivity to Cosmetics
Row 49, Column 0
Row 49, Column 1
Use of Sun bed
Row 50, Column 0
Row 50, Column 1
Acutance within 6 months
Row 51, Column 0
Row 51, Column 1
Cortisone within 6 months
Row 52, Column 0
Row 52, Column 1
Chemical or laser peel within 6 months
Row 53, Column 0
Row 53, Column 1
Retin A within 6 months
Row 54, Column 0
Row 54, Column 1
AHA preparations within last 2 weeks
Row 55, Column 0
Row 55, Column 1
Abnormal Heart Condition
Cold Sores (herpes simplex)
Mitral Valve Prolapse
Heart Murmur
Rheumatic Fever
Pacemaker
Artificial Heart Valves
Anaemia
Haemophilia
Prolonged Bleeding
High Blood Pressure
Low Blood Pressure
Circulatory Problems
Diabetes
Epilepsy
Fainting Spells or Dizziness
Thyroid Disturbances
Liver Disease
Kidney Disease
Glaucoma
Stomach Ulcers
Tumours, Growths or Cysts
Cancer
Tuberculosis
Stroke
HIV
Prosthetic Hip or Joint
Palpitations
Hepatitis
Cataracts
Blurred Vision
Dry Eyes
Eye Infection present
Alopecia
Recent Hair Loss
Watery Eyes
Contact Lenses
Eyelid Surgery
Chapped Lips
Trichollomania
Gore-Tex Implants/Silicone Injections
Fat Transfer Injections
Botox Injections
Collagen Injections
Hypertrophic Scars
Keloid Scars
Scar Easily
Healing Problems
Bruise or Bleed Easily
Sensitivity to Cosmetics
Use of Sun bed
Acutance within 6 months
Cortisone within 6 months
Chemical or laser peel within 6 months
Retin A within 6 months
AHA preparations within last 2 weeks
Yes
Row 0, Column 0
No
Row 0, Column 1
Yes
Row 1, Column 0
No
Row 1, Column 1
Yes
Row 2, Column 0
No
Row 2, Column 1
Yes
Row 3, Column 0
No
Row 3, Column 1
Yes
Row 4, Column 0
No
Row 4, Column 1
Yes
Row 5, Column 0
No
Row 5, Column 1
Yes
Row 6, Column 0
No
Row 6, Column 1
Yes
Row 7, Column 0
No
Row 7, Column 1
Yes
Row 8, Column 0
No
Row 8, Column 1
Yes
Row 9, Column 0
No
Row 9, Column 1
Yes
Row 10, Column 0
No
Row 10, Column 1
Yes
Row 11, Column 0
No
Row 11, Column 1
Yes
Row 12, Column 0
No
Row 12, Column 1
Yes
Row 13, Column 0
No
Row 13, Column 1
Yes
Row 14, Column 0
No
Row 14, Column 1
Yes
Row 15, Column 0
No
Row 15, Column 1
Yes
Row 16, Column 0
No
Row 16, Column 1
Yes
Row 17, Column 0
No
Row 17, Column 1
Yes
Row 18, Column 0
No
Row 18, Column 1
Yes
Row 19, Column 0
No
Row 19, Column 1
Yes
Row 20, Column 0
No
Row 20, Column 1
Yes
Row 21, Column 0
No
Row 21, Column 1
Yes
Row 22, Column 0
No
Row 22, Column 1
Yes
Row 23, Column 0
No
Row 23, Column 1
Yes
Row 24, Column 0
No
Row 24, Column 1
Yes
Row 25, Column 0
No
Row 25, Column 1
Yes
Row 26, Column 0
No
Row 26, Column 1
Yes
Row 27, Column 0
No
Row 27, Column 1
Yes
Row 28, Column 0
No
Row 28, Column 1
Yes
Row 29, Column 0
No
Row 29, Column 1
Yes
Row 30, Column 0
No
Row 30, Column 1
Yes
Row 31, Column 0
No
Row 31, Column 1
Yes
Row 32, Column 0
No
Row 32, Column 1
Yes
Row 33, Column 0
No
Row 33, Column 1
Yes
Row 34, Column 0
No
Row 34, Column 1
Yes
Row 35, Column 0
No
Row 35, Column 1
Yes
Row 36, Column 0
No
Row 36, Column 1
Yes
Row 37, Column 0
No
Row 37, Column 1
Yes
Row 38, Column 0
No
Row 38, Column 1
Yes
Row 39, Column 0
No
Row 39, Column 1
Yes
Row 40, Column 0
No
Row 40, Column 1
Yes
Row 41, Column 0
No
Row 41, Column 1
Yes
Row 42, Column 0
No
Row 42, Column 1
Yes
Row 43, Column 0
No
Row 43, Column 1
Yes
Row 44, Column 0
No
Row 44, Column 1
Yes
Row 45, Column 0
No
Row 45, Column 1
Yes
Row 46, Column 0
No
Row 46, Column 1
Yes
Row 47, Column 0
No
Row 47, Column 1
Yes
Row 48, Column 0
No
Row 48, Column 1
Yes
Row 49, Column 0
No
Row 49, Column 1
Yes
Row 50, Column 0
No
Row 50, Column 1
Yes
Row 51, Column 0
No
Row 51, Column 1
Yes
Row 52, Column 0
No
Row 52, Column 1
Yes
Row 53, Column 0
No
Row 53, Column 1
Yes
Row 54, Column 0
No
Row 54, Column 1
Yes
Row 55, Column 0
No
Row 55, Column 1
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1. I hereby authorise [enter technician's name] (microblading technician) 2. Of [enter company name] to perform the microblading/ombre brow treatment upon myself. If any unforeseen condition arises in the course of this procedure(s), calling in their judgement in addition to, or different from those now contemplated, I further request and authorise the technician to do whatever they deems advisable and necessary in the circumstances. 3. I accept responsibility for determining the colour, shape and position of the permanent cosmetic procedure as agreed during the course of my consultation. 4. I understand that an allergy test does not guarantee that I will not have an allergic reaction to the pigment. I confirm I have completed a patch test for this procedure, within 6 months of the treatment date. 5. I fully understand and accept that non-toxic pigments are used during the procedure and that the cosmetic enhancement achieved may fade in between 1-3 years. 6. I have been informed that the highest standards of hygiene are met, and that sterile disposable needles, and pigment containers are used for each individual client, procedure and visit. 7. I understand and accept that each procedure is a process requiring multiple applications of pigment to achieve desirable results and that 100% success cannot be guaranteed. I understand this is why I need to return for a retouch procedure. 8. I understand that a retouch procedure will be performed 1-3 months after the initial procedure and after a 3-month period I will be charged an additional fee for any further work. I will book the appointment when it is convenient for both parties. 9. The result of the procedure is determined by the following: - Medication - Skin Characteristics - (dry, oily, sun-damaged and thickness) - Natural skin undertones - (blending with chosen pigment) - Personal pH balance of skin, which changes from visit to visit - Alcohol intake and smoking - Post procedure care treatment 10. Upon completion of the procedure there may be swelling and redness of the skin, which will subside in 1-4 days. In some cases bruising can occur. You may resume normal activities immediately following the procedure, however, using cosmetics, excessive perspiration wetting and exposure to the sun on the affected area should be limited. See specific post-procedure instructions for details. You can however, be assured the procedure, even after only one treatment, looks acceptable and you should feel comfortable appearing in public without additional makeup on the affected area. 11. I have been advised that the true colour will be seen 1 month after each procedure, and that the pigment may vary in colour according to skin tones, skin type, age and skin conditions. I understand that some skins except pigment more readily than others and no guarantee to an exact effect or colour can be given. 12. I am aware that the lip procedures may stimulate any dormant virus such as herpes (cold sores). I am informed that eye procedures may stimulate dormant eye disorders or eye infections, and that some medication can prevent absorption of the pigment. 13. To my knowledge I do not have any physical, mental, or medical impairment or disability that might affect my well being as a direct or indirect result of my decision to have the procedure done at this time. I am at least 18 years old. I am not under the influence of drugs or alcohol, pregnant or breastfeeding. 14. I agree to follow all pre-procedure and post-procedure instructions as provided and explained to me by the technician. 15. Being of sound mind and body, I hereby release any and all responsibility. I accept any and all responsibility myself for any consequence that might stem from my decision to have any permanent cosmetics procedure performed by [enter technician's name] (microblading technician) 16. For the purpose of documentation, I also consent to the taking of “before” and “after” photographs of the microblading procedure(s)* This field is required.
I have read and understand the above information
25
Allergic Reaction– Allergic reaction can occur from any anaesthetics used during the procedure. If you do suffer from an allergic reaction you should contact your doctor immediately. Allergic reaction response may display redness, itching, swelling, a rash, blistering, dryness or any other symptom associated with allergy. Numbness - We cannot accept responsibility if the treatment area does not numb. Each individual is different according to the skin type. Some clients have reported that the area is totally numb while others say they experience some discomfort. Procedure – For all procedures a cream or gel topical anaesthetic is used. These products are perfectly safe, and can be purchased over the counter from any chemist. The anaesthetic is placed over the treatment area for between twenty to thirty minutes then carefully removed prior to treatment. Please be aware that you may experience swelling and redness that can last between one and four days. You should always follow your post procedure instructions.* This field is required.
I have read and understand the above information
26
Skin Type
27
Pigment Colour
28
Consultation Date:
29
Treatment Date:
30
Top-Up Date:
31
Location
32
Treatment Price
33
Top Up Price
34
Date Completed
Skin patch test
Row 0, Column 0
Pre instructions
Row 1, Column 0
After Care instructions
Row 2, Column 0
Before photos
Row 3, Column 0
After photos
Row 4, Column 0
Skin patch test
Pre instructions
After Care instructions
Before photos
After photos
Date Completed
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Date Completed
Row 1, Column 0
Date Completed
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Date Completed
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Date Completed
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