Form
Layra Lina Artistry
Full Name
*
For your artist use only
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
E-mail
*
sample@sample.com
Date of Birth
*
-
Ay
-
Gün
Yıl
Date
Occupation
*
How did you hear about us?
*
MEDICAL HISTORY
Please answer to your best knowledge
Are you currently under the care of a doctor or hospital specialist? If yes, please list the relevant details of your Doctor and condition
*
Please list any medication you are taking
*
Are you pregnant or nursing
*
Yes
No
Do you smoke?
*
Yes
No
Do you have previously Microbladed/tattooed brows? If YES please please send picture of your brows/lips/eyeliner to layralinaa@gmail.com before continuing to fill out this form
*
Yes
No
If you have previous Microblading/tattoo on brows lips or eyes please note that correction work may require additional touch ups as skin quality can be compromised and there might be scar tissue underneath the pigment. Results are never guaranteed. Additional touch up price is $150 for each procedure. Please initial
*
Eczema or Psoriasis on any part of your face?
*
Yes
No
Oily skin?
*
Yes
No
Bleed easily?
*
Yes
No
Diabetes?
*
Yes
No
Autoimmune disorders?
*
No
If yes name condition
Abnormal heart condition?
*
Yes
No
Taking blood thinners?
*
Yes
No
Allergies?
*
No
If yes what kind
Anxiety?
*
Yes
No
Prone to herpes/ cold sores?
*
Yes
No
Consumed drugs or alcohol within last 24hrs?
*
Yes
No
Epilepsy?
*
Yes
No
Rosacea?
*
Yes
No
Very thin skin?
*
Yes
No
Problems with wound healing?
*
Yes
No
Scars in pigmented brow/lip area?
*
Yes
No
Prone to keloid scars?
*
Yes
No
Allergies to numbing agents?
*
Yes
No
Using Acutane or any other Acne treatments?
*
No
If yes please add last treatment date below
Chemical peels or lasers?
*
No
If yes please add last treatment date below
Botox or fillers?
*
No
If yes please add last treatment date below
Chemical peels or lasers?
*
No
If yes please add last treatment date below
Cancer?
*
No
If yes please add last treatment date below
I understand the importance of my accurate and complete medical history. And that withholding any medical information may be detrimental to my health and safety during the procedure. I understand that if there is any change in my medical history that it is my responsibility to advise my specialist.
Before and after instructions will be explained orally and a written copy will be given to me to retain in my possession which I will follow to the best of my ability
*
I understand
I understand that permanent makeup outcome cannot be guaranteed. There are so many variables (medications, skin care routine, lifestyle, aftercare etc related to each client that affect the outcome of any permanent makeup procedure.
I understand
I understand that implanted pigment can turn color or fade over time due to circumstances beyond the control of the performing technician and alter the original pigment color.
*
I understand
I understand that I will need to maintain color with future applications.
*
I understand
Sun, skin care products, pools, and other factors can contribute to pigment fading.
*
I understand
I understand and accept all risks and possible complications that may arise from this procedure.
*
I understand
I understand that eyebrows will look up to 40% darker and 20% thicker right after
*
I understand
I acknowledge that touch up is not included in the initial price and it costs $150. Touch up has to be done between 5-10 weeks from my original appointment and it is my responsibility to schedule that touch up.
*
I understand
I understand that perfect symmetry is not always possible because of the negative impact of facial expression. Symmetry might be corrected with permanent makeup but botox can be advised to correct it.
*
I understand
I hereby consent to having permanent makeup applied by Layra Lina Artistry
*
I understand
I acknowledge that the proposed procedure(s) involve risks inherent in the procedure and the possibility of complications during the procedure. Those complications can be, but are not limited to, infections, poor color retention, or hyperpigmentation.
*
I understand
I have answered all questions truthfully and to the best of knowledge.
*
I understand
I understand that I can have an allergy reaction to any products used during the procedure.
*
I understand
Patch test can be done but does not guarantee that a reaction will not occur, even years later.
*
I understand
I certify that I have read and understand all of the above.
*
I understand
I understand that there will be no refunds after treatment of this procedure. I understand that my payment covers the initial application and I might need touch up within 30-5 days from the initial application that will cost $150. I understand that I might need additional touch ups to achieve desired results and each touch up cost $150. It is the responsibility of the client to contact the technician to schedule a touch up. I understand that my touch up cannot be done earlier than 5 weeks from original appointment and if it's done laterthan 12 weeks it will be priced as Color Boost appointment which costs $350.
*
POLICY
Last minute cancellations hurt small businesses. Please note that we have 48 hours cancellation and 15 min late policy.If you decide to cancel with less than 48 hours notice or if you no show to your appointment it will result in charge of full cost of service. You may also be required to rebook and pay a new deposit if you wish to continue with your procedure after arriving late or providing a short notice cancellation. Please note that if you fail to disclose your previous Microblading/tattoo prior to arriving to your appointment and we can not work on your brows/lips , your appointment will be cancelled and you will be charged 50% service fee.Please note that if we can not agree on shape/ style for your brows during the appointment we can decline to service you. Every artist have their specific style. Layra custom draws the shape for every client that suits their face. She also suggests proper technique based on clients skin type/ their current brow shape etc. It is important that you put faith in the process of designing the brows shape based on your facial symmetry, muscles etc. I have read and agreed to the terms of the above office policy.
Date
*
-
Ay
-
Gün
Yıl
Date
Send
Send
Should be Empty: