Ombre Brow Cosmetic Tattoo Application
Before You Begin
Thank you for your interest in Ombre Brow Cosmetic Tattooing at Kelaya Beauty. This application helps us determine whether this treatment is suitable for you and allows us to begin planning your appointment. Every application is personally reviewed to ensure we can provide the safest treatment and achieve the best possible outcome. Please note that submitting this application does not guarantee treatment. If we have any concerns regarding your suitability, we’ll be in touch to discuss your options.
Personal Details:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
E-mail
*
example@example.com
Date of Birth
*
/
Month
/
Day
Year
Date
Gender
Male
Female
Other
Age
*
Occupation
*
Tell us about your brows
Have you previously had cosmetic tattooing on your brows?
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Yes
No
If yes, approximately when was your last treatment?
Have you previously had laser or saline removal on your brows?
*
Yes
No
If yes, please provide details
Medical History
Please select any of the following that apply to you.
*
Diabetes
Autoimmune condition
Blood clotting disorder
Heart condition
High blood pressure
Thyroid disorder
Compromised immune system
Anaemia or iron deficiency
Anxiety or depression
Prone to keloid scarring
None of the above
If applicable, please provide details
Are you currently taking, or have you taken within the past 12 months, any medications that may affect cosmetic tattooing? Examples include Roaccutane/Isotretinoin, blood thinning medication, steroids or immunosuppressant medication.
*
Yes
No
If yes, please list the medication(s) and any relevant details.
Do you have any known allergies or sensitivities to any of the following?
*
Local or topical anaesthetic (lignocaine, tetracaine, prilocaine, epinephrine)
Latex
Adhesives
Tattoo pigment
Other
None
If applicable, please provide details.
Are you pregnant, planning pregnancy or breastfeeding?
*
Yes - pregnant
Yes - planning pregnancy
Yes- breastfeeding
No
File Uploads
Please attach the photos requested below. Ensure your brows are shown in their most natural appearance and avoid submitting photos taken after a brow service, such as waxing, tinting, dye or lamination. Clear, recent photos in natural lighting are preferred. These photos help us assess your suitability and begin planning your treatment.
Please attach a clear image of your FULL FACE with no make-up on (Please take in clear natural light)
*
Browse Files
Cancel
of
Please attach a clear image of your LEFT EYEBROW with no make-up (Please take in clear natural light)
*
Browse Files
Cancel
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Please attach a clear image of your RIGHT EYEBROW with no make-up (Please take in clear natural light)
*
Browse Files
Cancel
of
Please attach a clear image of your driver’s license or ID
*
Browse Files
Cancel
of
Your Goals & Preferences
What are you hoping to achieve with your brows?
Is there anything specific you would like us to know about your desired result, concerns or expectations?
When are you hoping to have your first appointment?
*
As soon as possible
Within the next 3 months
More than 3 months from now
I’m flexible / just exploring my options
What days generally suit you best for appointments?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
What is your preferred method of contact regarding your application?
*
SMS
Phone call
Email
No preference
Before you submit
Please carefully read through and acknowledge your agreement to the following statements.
I understand my application and photographs will be reviewed to assess my suitability for cosmetic tattooing, and submitting this application does not guarantee treatment or an appointment.
*
Yes, I understand
I understand cosmetic tattooing is custom and artistic in nature, and that immediate or healed results, including colour, shape and pigment retention, cannot be guaranteed.
*
Yes, I understand
I understand Ombre Brow Tattooing is a compulsory two-session process, with the second session required to complete the treatment. I understand the second session is required 6-8 weeks after the first session, is booked separately and incurs an additional cost.
*
Yes, I understand
I understand cosmetic tattooing creates a permanent change to my appearance. Removal or correction may require laser, other removal methods or surgical intervention, and may not restore my skin to its original appearance.
*
Yes, I understand
I confirm that the information I have provided in this application is true and complete to the best of my knowledge. I understand that withholding relevant information may affect my suitability for treatment, and I agree to notify Kelaya Beauty if any relevant information changes before my appointment.
*
Yes, I understand and accept
Signature
*
Date Signed
*
-
Month
-
Day
Year
Date
Submit
Submit
Have you ever been diagnosed with any medical conditions that may affect healing, bleeding, immune function or your suitability for cosmetic tattooing?
*
Yes
No
Are you able to use topical anaesthetic? (lignocaine, tetracaine, prilocaine, epinephrine)
*
Yes
No
Do you have oily skin?
*
Yes
No
Do you have any health concerns?
*
Yes
No
Are you iron deficient or anaemic?
*
Yes
No
Are you prone to keloid scarring?
*
Yes
No
Do you suffer from anxiety/depressions?
*
Yes
No
Should be Empty: