E-Consultation

Welcome Sheet - Client Information
Full name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
example@example.com
Phone Number
Emergency contact

First NameLast Name
How did you hear about us?*

Friend or Family MemberGoogle SearchYelpOther
Please attach a BRIGHT, CLEAR photo of face*

Cancelof
Have you previously had a permanent makeup treatment?

YesNo
Have you had botox or fillers within the last 2-6 weeks?

YesNo
Have you previously had any body tattoos?

YesNo
How does your skin react to sun exposure?

Always burnSometime burnsRarely burnsNever burns
Are you or have you been pregnant in the last 12 months?

YesNo
Are you currently breast feeding?

YesNo
My Products
prevnext( X )
Brows
$450.00



Brow Boost with in 1 year
$100.00



Brow Boost with in 2 years
$250.00



Eyeliner Upper
$350.00



Eyeliner Winged Upper
$375.00



Eyeliner Upper & Lower
$400.00



Lip Blush
$400.00



Total

$0.00
Select the service your interested in

BrowsEyelinerLips
I am seeking a look for my brows that

looks like I have makeup on my browslooks like I have a barely there stain of colorlooks like I have more hairlooks like I have both more hair strokes and a shade of colorOther
I am seeking a look that is

SubtleMaderateDermatic
I use makeup on my brows daily

YesNo
My brows are best described as

SparseUnevenThinToo Far ApartToo Close TogetherToo LightLacking ShapeMissing or HolesLacking Definition
My brow makeup in comparison to my natural brow is

DarkerLighterSame Color
Do you have or have you had cold sores or fever blisters in the past?

YesNo
Please use this comment box to tell us about any items listed above that may need a short explanation.
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Welcome Sheet - Client Information