BEAU Health Assessment Form

Health Assessment Form

Please take a moment to answer this form as accurately as possible to communicate all past and existing medical conditions.
Full Name

First NameLast Name
Date of Birth

MonthDayYear
Mobile Number

Area CodePhone Number
Email
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about us?
When is your preferred appointment date for the procedure? 📌 At least a week ahead to allow time for your e-consult and skin prep.

MonthDayYear
Date
What is your skin type?
Is this your first time getting permanent makeup on your brows? If no, you must ensure the pigment is faded at the time of appointment.
Are you currently pregnant or breastfeeding? If yes, you must not be pregnant or nursing at the time of appointment.
Do you have any blood borne pathogen diseases including but not limited to: MRSA, Aids/HIV, Hepatitis (A,B,C,D)?
Have you had Botox within the past 6 months in the brow/forehead area?
Have you had any eye surgeries including blepharoplasty (eyelid surgery) and/or forehead/brow lift?
Are you using any anti-aging, skin brightening or anti-acne skincare products that contain Alpha Hydroxy (AHA), Vitamin A, Retinol?
Have you undergone any facial treatments such as microdermabrasion, microneedling, chemical peel, tanning, waxing, exfoliation, or laser within the past 4 weeks?
Have you ever had adverse reactions to any previous treatments?
Allergic reaction to any medications such as Lidocaine, Epinephrine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylene Glycol, Vitamin E Acetate, etc.
Are you currently on any blood-thinning prescription drugs such as Aspirin or Coumadin?
Have you experienced a recent sunburn?
Please check all that applies to you:
Any medical conditions not mentioned above?
If you have undergone eyebrow tattooing in the past, when and where was it done?
What specific concerns or preferences do you have for your eyebrows?
Please upload good quality photos of your full face with bare brows taken with natural lighting and from different angles below. You may submit up to five photos.

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CLIENT AGREEMENT
I acknowledge the importance of providing complete and accurate information regarding my medical and health history for my safety and the success of the treatment. The artist will assess my suitability for the procedure based on this information.

Upon submitting this form, I agree to undergo a consultation prior to my treatment, which will be scheduled accordingly. This consultation is crucial to confirm my suitability for the procedure and to receive guidance on my options.

By signing below, I confirm that the information I have provided is true and complete to the best of my knowledge. I understand that providing false or incomplete information may result in personal harm and negatively impact the outcome of my treatment.
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Date

MonthDayYear
Date
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Health Assessment Form

CLIENT AGREEMENT