PMU Appointment Request
Creatrix Cosmetic Tattooing
Must be over 18 years of age with a valid state ID or passport
What days work best for you?
What time works best for you?
Are you responding to a model call?
Service Interested in:
Hair Stroke Brows
Solid Color Brow
Freckles & Beauty Marks
Novocaine, Lidocaine, Epinephrine
General Medical (Check all that apply to answer "YES")
Have you ever had a fever blister, even one in your entire lifetime? Even as a child.
Are you pregnant or nursing?
Do you have glaucoma or other eye disease or disorders?
Have you had a vision correction procedure, such as Lasik or Cataract surgery in the the last 3 months?
Are you considering having vision correction procedures in the next month?
Are you prone to eye infections?
Are you on blood thinning medication?
Are you on Accutane, for acne, and have you taken it within the last year?
Do you have heart disease or a heart condition?
Have you had a heart attack within the past year?
Prior dental procedures / Are you on antibiotic therapy?
Steroids or Anti-inflammatory medications?
Seizure or fainting spells?
Do you bruise easily?
Do your scars heal in a raised manner?
Do you scars heal in a darker color?
Do you have keloids?
Do you use Retin-A, Glycolic Acid, Vitamin C, or other acid exfoliants?
Do you have dermatological disorder(s)?
Are you headed for a beach vacation or use a tanning bed in the next few weeks?
Are you currently tan in the areas to be treated?
Do you have hemophilia or other clotting disorders?
Do you have an autoimmune disorder?
Have you ever had hepatitis?
Do you have any pre-exisiting nerve damage in the area that I will be working?
Have you ever had Bell's palsy?
Active or in flare up?
Do you have any tattoos?
Do you have a hyper active thyroid or Grave's disease?
Do you have Trichotillomania?
Do you have Alopeacia Universalis?
Do you tint your brows?
Do you tint your lashes?
Have you had Botox
Fat transfer injections?
Aesthetic or Cosmetic Surgery?
Planning on Cosmetic Surgery in the near future?
Do you practice any outdoor activities regularly?
Last one, I swear, are you presently under a physician's care for any condition
Please provide details to any of the above questions that you've answered "yes" to here:
We ask for the clients ethnicity to determine the degree of blue in their skin that may not be visible, but is in their ethnicity. The more color (Olive to African American) the more blue and the more warmth your color formula will require.
Example: "My father is Italian, and my mother is Scottish."
Please attach photos of your brows or lips here:
I would like to be notified about promotional services.
Should be Empty: