Full Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Microblading Prescreening
It is essential to pre-screen to ensure that the client is a suitable candidate to safely receive the Microblading procedure. Please answer the following questions accurately and to the best of your knowledge. We will contact you within 48 hours to discuss and confirm your appointment and how to prepare. Thankyou!
Email
*
example@example.com
Name
First Name
Last Name
How did you hear about us?
*
Have you had Botox within the last two weeks?
*
Yes
No
Do you have allergies to latex?
*
Yes
No
Are you nursing, pregnant or suspect you might be pregnant?
*
Yes
No
Are you diabetic?
*
Yes
No
Do you have an auto immune disease?
*
Yes
No
Are you taking blood thinners/aspirin/heart medication?
*
Yes
No
Do you have any medication allergies?
*
Yes
No
Not Sure
Do you have very oily skin?
*
Yes
No
Would you like to book a patch test prior to appointment? (Recommended for individuals with high skin sensitivities that are sensitive to topical makeup products, gold, silver, nickel, and hair dyes.) Must be scheduled at least 24-48 hours prior to appointment.
*
Yes
Decline patch test
**Try to avoid booking during menstruation or a few days before as pain tolerance plummets and there will be increased bleeding during the procedure.**
Submit
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