SALINE REMOVAL CONSULTATION FORM

Name

First NameLast Name

Email

example@example.com

Birth Date

MonthDayYear

Do you have any of the following medical or skin concerns - especially in the area of the tattoo - that I should be aware of? (Check all that apply)

If other, please explain:

What technique was used? (Brow's only)

How many times have your eyebrows been Microbladed/tattooed (including any touch ups)?

When was the last time your eyebrows were microbladed/tattooed?

Did Bethany do your previous Microblading/tattoo?

Have you tried other removal methods?

Please describe what makes you unhappy about your current brows/previous Microblading/Tattoo.

What goals would you like to achieve for your brows/tattoo with this procedure? i.e Complete removal or lightening?

Do you plan to have your eyebrows Microbladed/tattooed again in the future?

Please submit clear photos of your current brows below. (It it usually helpful to have someone else take the photos for you if possible. )