PMU online consultation

1

Name* This field is required.

First Name

Last Name

2

Phone Number* This field is required.

Please enter a valid phone number.

3

Email* This field is required.

example@example.com

4

Are you 18 years or older?* This field is required.

YESNO

5

Have you ever received a permanent makeup service?* This field is required.

YESNO

6

If yes, which services have you received?

Brows: microblading/hairstrokes

Eyeliner

Brows: powder brow/ombre brow

Lips

7

How long ago was your last permanent makeup service?

8

What service are you interested in?* This field is required.

Brows

Lips

Eyes

9

Please take a photo of your face* This field is required.This will help me give you advice about which technique to use.

10

Please upload an inspiration picture of what you like

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

11

Are you currently pregnant or breastfeeding?If yes, you must not be pregnant or breastfeeding at the time of your appointment.

YESNO

12

Have you had Botox within the past 6 months in the brow/forehead area?

YESNO

13

Are you allergic to Lidocaine?

YESNO

14

Are you currently on any blood-thinning prescription drugs?* This field is required.

YESNO

15

Please check all that applies to you:* This field is required.Press select items to check the boxes

16

Can you agree to the following:

I will not use alcohol 24 hours before my treatment permanent makeup service
I will not swim or go into a sauna for 7 days after the service
I will not go into the sun for 7 days

I blanks * (fill in: agree/ can't agree) to the points mentioned above .