Powder Brows Intake Form ($400)
Powder Brows/Microshading is a technique using permanent ink to create tiny pixels into the skin to achieve a soft shadowy makeup look. This look can be customized to be as bold or as soft as you like and can typically last 1-3 years
Client Name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Have you had permanent makeup on your brows?
*
Yes
No
If so, please describe
Please check any and all conditions that apply to you as listed below:
*
Diabetes
Hemophilia
Heart Condition
Herpes at the site
Epilepsy
Scarring/Keloiding
Eczema/Psoriasis
Blood Thinners
T.B.
Pregnant/Nursing
Skin Condidtions
Hepatitis B/C
Allergic Reaction to Latex or Antibiotics
Blood pathogens risks, including but not limited to AIDS and HIV
History of medication use or are using medication (including being prescribed antibiotics prior to dental or surgical procedures)
NONE
Terms and Condidtions
I certify that I am at least 18 years of age
Yes
I understand that said tattoo is permanent and administered by penetrating the skin with pigment
Yes
I understand that there is a chance I might feel light-headed and/or dizzy during or after being tattooed
Yes
I understand that there is possibility of an allergic reaction
Yes
I understand that there is possibility of an infection
Yes
I understand that overtime colors and clarity of tattoo will fade due to unprotected exposure to the sun and the naturally occurring dispersion of pigment under the skin
Yes
I understand that the FDA has not approved of any inks, dyes, or pigments and that health effects are unknown
Yes
I have not ingested aspirin/ibuprofen, alcohol or caffeine within 24 hours prior to this appointment.
Yes
I Understand permanent makeup may require a 2nd session after 6 weeks to achieve desired results
Yes
I will agree to follow aftercare instructions pertaining to the body art procedure
Yes
I give Secret Ink consent to use photos for marketing purposes
Yes
Please upload clear picture of bare brows
*
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Please upload a photo of ID
*
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Client Signature
*
Date
*
-
Month
-
Day
Year
Date
Aftercare
Gently wash off ointment in soft circular motions with the provided soap
Pat dry with clean paper towel
Apply a THIN layer of ointment on brows (with clean finger or Q-tip)
Repeat this process morning and night for 10 days
Brows may feel tender for the first 3 days
Avoid swimming, sauna, and excessive sweating for the first week
Avoid direct sunlight
Feel free to call/text me with any questions 💕
Submit
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Adriana Magana | 650-445-9672 | 45 s Claremont St San Mateo, Ca 94401
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