Tattoo Removal - Online Consult

1
What is your skin type?* This field is required.Select ALL that apply.
Dry
Oily
Normal
Combination
Eczema, Dermatitis, Psoriasis
Problematic/Active Acne
Rosacea
Textured/Porous
2
Please tick which of the following apply to you:* This field is required.Please select ALL that apply. Not all of these boxes rule a client out of removal. It may just require a date reschedule or a discussion about how we can make you eligible for this procedure.
Under 18 years old
Pregnant, planning a pregnancy, or breastfeeding
Have had sunburn/peeling skin on the face in the past 30 days
Currently using products containing Retinol, Retinate or Retin
Had a cold sore before
Had botox in the past 3 weeks/planning botox in the next 3 weeks
Suffer from vertigo/severe back pain
None of the above
3
Please list your current medications or supplements:* This field is required.The pill, anxiety/depression meds. blood thinners, pain medication, fish or krill oil etc.
4
Please list any health/medical conditions or allergies:* This field is required.Heart concerns, blood disorders, communicable diseases, healing problems, latex allergies etc.
5
Please describe the tattoo to be removed:* This field is required.Please advise the tattoo location (face, brows etc) and use comparables to describe the size of it (10c piece, size of a playing card etc). What don't you like about it? Why do you want to remove this tattoo? Please be as detailed as possible.
6
How long ago did you get this tattoo, and how many times has it been worked on?:* This field is required.For tattoos under 72 hours old, please specify how many HOURS old the tattoo is. For old work, please specify in years. Please specify the number of times it has been worked on by ANY tech, touch-ups included.
7
What would you like to achieve out of tattoo removal?* This field is required.Select ALL that apply.
Complete removal
Lighten the area for a new tattoo
Spot removal of a portion of the tattoo
Breakdown scar tissue/improve skin texture
Whatever is possible
8
Do you have any questions, comments or concerns we could answer for you?* This field is required.Anything relating to the service and what's involved, health conditions, policies or how it works!
9
Have you ever had any removal services completed on this tattoo before?* This field is required.Select ALL that apply.
Yes, laser
Yes, saline removal
No
10
Upload a photo clearly showing the tattoo:* This field is required.Please ensure this photo is clear, shows the tattoo, no filters, no makeup (brows).
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
11
Let us know your details so we can get back to you!* This field is required.We will only use these details to get in contact with you regarding your eligibility for this service.
Full Name
Email Address
Mobile Number
Should be Empty: