Consultation Form

Consultation Form

This form is for a consultation only if you are unsure if you are ready to book an appointment, or have questions or concerns. A portion of this form is a part of the regular appointment process. This does not replace booking an appointment with a deposit, and this is not your consent form. Please book an appointment through this link if you are ready for an appointment https://kaylaxxnicolepmu.as.me/
Full Name*

First NameLast Name
Contact Number*
Please enter a valid phone number.
Email Address*
example@example.com
Preferred method of contact

Phone callText messageEmail
How did you find us?

Referral (please list who in the "other" optionGoogleInstagramFacebookOther
Do you know what service you are most interested in?

MicrobladingPowder BrowsCombo BrowsOpen
Do you know what the different services are, and why different techniques are used?

YesNoNot sure/Need help
What is your skin type in the area to be serviced (in the t-zone)?

DryNormalOilyOther
How often do you fill in your brows?

DailyA few times a weekOnly for special occasionsNever
What brow products do you currently use?

PencilPowderPomadeBrow Gels
1. Have you ever had previous permanent cosmetic tattoos on your brows? If yes, please answer the following questions.

YesNo
1b. About how long ago was your prior permanent makeup done? How many times?
1c. Have your brows faded to an undesired color? Or are they too dark?

No (I'm still happy with the color)They're very light/ fadedThey're gray/blueThey're reddish/warmToo dark for meOther
1d. Are you currently happy with the shape of previous permanent makeup?

YesNo longer happy, but was happy when they were first doneNo, was never happy when they were first doneOther
1e. Were you happy with your prior work when it was first done? If not, please write why not below.
1f. Any other concerns or information about your prior work? There is a space to add photos at the end of this form.
If your brows are too dark, or too full of color, are you open to removal recommendations (laser, saline removal)?

YesNoNot sureOther
What are your biggest concerns, if any?

PainResults being too darkResults not being symmetricalThe healing process afterwardsLooking too "tattooed"Other
Have you ever had any of these services done? (References for pain tolerances as the services below are generally more painful than microblading.)

Brow WaxingBrow ThreadingBotox/Facial FillersMicrodermabrasionOther
Do you have any of the following contraindications?

Under the age of 18Currently PregnantUsed Accutane within the last yearProne to keloids (not hypertrophic scars)Moles in the area to be tattooed (cannot be covered with tattoo. only around it)Uncontrolled DiabetesAutoimmune disorderAbnormal heart conditionEpilepsy/seizuresHIV/AIDSHepatitisCurrently undergoing chemotherapy or radiationCurrently taking blood thinning medicationsHemophilia or bleeding disorderOther
Do you have any allergies? If yes, please describe in “other” box

YesNoOther
Are you interested in a phone consultation? Consultations are generally done at all services and are not always necessary as a separate in person appointment.

YesNo, I'd prefer in personNot sureOther
Are there any days of the week that work best for you?

MondayTuesdayWednesdayThursdayFridaySaturdaySundayAny dayVariesOther
Are there any times of the day that work best for you? (Depending on what you're wanting to book, consultations take about 10-20 minutes. New client appointments are 2 hours long.)

Morning (10/11am)Afternoon (12/1/2pm)Evening (3/4pm)Any timeVariesOther
Do you have an event you want your brows done prior to?

YesNoOther
Add photos of current brows, inspiration photos, or anything you think is relevant for a consultation.

(You do not need to use all the available options to upload, unless needed.)
Photo 1
Photo 2
Photo 3
Photo 4
Photo 5
Photo 6
Photo 7
Photo 8
Please describe the images you added (prior work done, inspiration, current brows, etc.).
Is there anything else you'd like to discuss?
Should be Empty: