• Image field 43

  • Health Questionnaire

    This information is required to determine if you are a qualified candidate for microblading procedures. Please answer completely and honestly. Thank you.
  • Date
     - -
  • Format: (000) 000-0000.
  • How did you hear about my services?*
  • 1. Will you be 18 years of age or older at the time of procedure?*

  • OH NO!!  I'm sorry but I cannot perform a microblading procedure on anyone under the age of 18.  However, I would love to hear from you once you are officially an adult!  Please reach out to me then and we will get you scheduled... in the meantime, come follow me on Instragram.

    XOXOX

  • Image field 74
  • 2. Have you ever had permanent make-up?*
  • 2b. Were you satisfied with the results?
  • 3. Have you had any facial injections (such as fat, Botox, or collagen) or any other facial procedures in the last 30 days?*
  • 4. Are you pregnant or lactating?*
  • 5. Have you undergone any recent surgeries?*
  • 6. What medications are you using?*
  • 7. Have you had, or do you currently suffer from any of the following conditions?*
  • 8. Do you have any known allergies? (Foods, latex, chemicals, antibiotics, medications, etc.)*
  • 9. Do you have sensitivities or allergies to any ingredient in tattoo creams, pigments, dyes, antiseptics, or petrolatum jelly?*
  • 10. Do you have a history of adverse reactions to any medical or dental anesthetics (topical or local)?*
  • 11. Have you ever been prescribed antibiotics prior to a medical or dental procedure?*
  • 12. Have you been vaccinated with the COVID-19 vaccination?*
  • 13. Have you, in the past 10 days, experience any COVID like symptoms?*

  • * If you DO experience any COVID symptoms within 10 days of your appointment, please let me know. I'd be happy to reschedule. 💖

  • 16.  If you have ever had a prior eyebrow procedure (with pigment still showing) please upload close up photos of your eyebrows without makeup on them, just like the examples shown below.  There should be 3 photos total and they MUST be clear.  Thank you.

    * If you have already submitted a photo or I've already talked to you in person, this is not required. 

  • Upload Photos
    Drag and drop files here
    Choose a file
    Cancelof

  • Example of photos to upload:

  • Image field 96

  • Additional Procedure Information

  • Microblading should be considered a multi-session process and you will need to come back for a touch up within 4-6 weeks.  Please be prepared for the color intensity of the procedure to be significantly bolder, darker, and sharper until they are healed. Healing takes approximately 3 weeks, however, each person heals differently.  Because of this, individual results may vary and it may take multiple sessions before you get the final result.  

    In addition, delicate and sensitive skin may swell slightly or redden for a short time after the procedure.  Please keep this in mind if you are planning on attending a significant event within the following day or two.  Allow a minimum of 1 month for your eyebrows to heal for any significant event.  You can wear your normal makeup on the day of the procedure.

  • Should be Empty: