Client Pre-Consultaion Form

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📋 The application includes Client Requirements for Permanent Makeup (PMU) eligibility and Disqualification criteria for clients who may not be suitable for the procedure.

🚫Who may not be suitable to get the procedure🚫:
- Pregnant or nursing
- Under 18 years of age
- History of skin diseases or conditions that may affect the procedure
- Recent surgeries or medical treatments (consultation required)
- Existing medical conditions or allergies (consultation required)
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Name* This field is required.
First Name
Last Name
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Birthdate* This field is required.For Special Promo
Date
Year
Month
Day
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Email* This field is required.
example@example.com
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Phone Number* This field is required.
Please enter a valid phone number.
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Instagram* This field is required.Skip if you don't have one
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Preferred Method of Contact* This field is required.
Email
Call
Text
Video Call
Any
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How Did You Hear About Us?
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I am 18 or Older* This field is required.
YESNO
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Pregnant or Breastfeeding* This field is required.
YESNO
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Epilepsy * This field is required.
YESNO
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Diabetic* This field is required.Please Consult with a Doctor Prior to Booking. A Doctor Note/ Clearance is required.
YESNO
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Accutane In The Past Year* This field is required.
YESNO
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Viral Infectious and/ or Disease* This field is required.
YESNO
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Chemotherapy * This field is required.Please Consult with a Doctor Prior to Booking. A Doctor Note/ Clearance is required.
YESNO
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Botox Within 4 Weeks Of The Appointment* This field is required.
YESNO
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Facial Chemical Peel Within 2 Weeks The Appointment* This field is required.
YESNO
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History of Keloids or Hypertrophic Scarring * This field is required.(Ombre Powder Brows Tattoo is Fine)
YESNO
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Skin Irritations, Psoriasis, or Eczema Near The Treated Area* This field is required.(Rashes, Sunburn, Acne, etc.)
YESNO
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Are You Vaccinated? If Yes, Was It Over 3 Weeks Ago?* This field is required.
YESNO
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Do You Have Any Medical Concerns/ Questions?Type them down below
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Have you ever had permanent makeup? If yes, please specify the specific procedure and date of service.
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Do you have any existing medical conditions or allergies? (Yes/No)If yes, please provide details.
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What's Your Skin Type* This field is required.
Dry
Oily
Normal/ Combination
Sensitive
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Which permanent makeup service are you interested in?* This field is required.
Micro-shading - combination of hair strokes and ombre powder brows
Ombre powder brows - soft makeup look
Lip Blush
Lip Neutralization
Wing/ Dusty Eyeliner
Saline Tattoo Removal
In-person Consultation
Brow Correction
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Please provide 3 photos of your bare face without makeup or filter. The Photos should be clear and in good lighting. See below image on how to take angle the photo.
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Please upload a photo of the left side of your face.* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Please upload a photo of the front part of your face.* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Please upload a photo of the right side of your face.* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Please indicate your availability for the procedure (Months, Date, and Time).* This field is required.
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Date
Date
Month
Day
Year
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Disclaimer: By submitting this form, I acknowledge and agree that the information provided will be used for scheduling and conducting the permanent makeup procedure. I grant permission for before and after photos/videos to be taken during the procedure, and I understand that these images/videos may be used for social media, marketing, and portfolio purposes by the permanent makeup service. I am aware that reasonable efforts will be made to exclude or obscure personal identification information from the images/videos. I have read and understood the terms mentioned above.* This field is required.
I acknowledge and accept
Should be Empty: