Englishartistry
Jenna English
Billings, MT 59102
englishartistry.mua@gmail.com
(406) 321 - 2082
Client Details:
Full Name
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First Name
Last Name
Age:
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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E-mail
*
example@example.com
Referred By:
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Please note full name if referred by Friend or Family. If found via websearch - please specify!
Please mark all that apply:
I am allergic/sensitive to lidocaine
I am allergic/sensitive to latex
I am or have been pregnant in the last 12 months
I am currently breastfeeding
Have you had a laser treatment or microneedling within the last 6 months to a year?
I have a thyroid condition
I use an exfoliating facial product often
I frequent tanning beds
I wear contacts
I am prone to colds sore/ Herpes/ Fever blisters. (Even if I have ever only gotten one)
I take blood thinning medication
I have a bloodborne illness
I have had previous permanent makeup (if yes, please list below to tell me which procedure, how long ago, and exactly how much color remains)
I am a diabetic
I am currently using eyelash serums or I have in the last 6 months
I have been on Accutane in the last 12 months
I have had Shingles on my face
Other
I am Interested in:
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Brows
Lips
Eyeliner/Lash Enhancement
Other
Please list all medications, supplements, and vitamins you take. Including prescriptions and over the counter medications.
Please use this comment box to tell us about any items listed above that may need a short explanation. If you marked that you have had your permanent makeup previously done, please let us know how long ago, which procedure, and how much color remains.
If I have checked "yes" that I am prone to Herpes/Cold Sores/, I am required to consult with my Physician about anti-viral options before scheduling a LIP procedure. I understand that it is my responsibility and that I may be asked to show Physician Approval and/or Prescription prior to beginning my procedure. An outbreak during healing can disrupt the final result of my procedure, and this will not be the fault of the technician.
Yes
No
Not Applicable
Appointment Date if Already Scheduled:
*
Please attach a BRIGHT, CLEAR, MAKEUP-FREE photo of your brows if you have previous permanent. It is typically best to have someone else take the photo for you. Please do not send blurry photos
*
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