Permanent Makeup Request Form

Please note you are NOT a candidate for permanent makeup if any of these apply to you:

Pregnant
Under 18
Are currently using Accutane (Isotretinoin) or have used Accutane within the last year
Have a freshly tanned/sunburned face
Are on blood thinning medications
Have Rosacea
Have Eczema, Psoriasis or Keratosis Pilaris
Are undergoing chemotherapy treatment

Name*

First NameLast Name

Date of birth (must be over 18)*

Date

Which service are you requesting?*

Eyebrow Permanent MakeupFaux Freckles

For Faux Freckles please provide a reference photo of the amount of coverage you’d like. Pricing and time allotted is based on how much coverage is requested.

Please provide a cell phone number with text capability*

Please enter a valid phone number.

Do you have previous permanent makeup on your brows?*

YesNoN/A (mark here if you are requesting a freckle appointment)

For brow inquiries: If you have previous work that is not at least 75% faded or in an unsavory shape/pattern you may not be eligible. If this is the case, I may recommend removal prior to starting a new set of brows.

Please provide a forward facing photo in good lighting with NO MAKEUP*

Policies
1. All appointments require a non refundable booking fee to secure an appointment. Once approved for booking, you will receive an invoice via square in a text message. This fee MUST be paid within 48 hours of receipt or the appointment will be forfeited.

2. Cancel/reschedule/no show: Cancellations or rescheduled appointments with less than 48 hours notice, will lose their booking fee and require a new one to reschedule. Being over 15 minutes late for your appointment may require the need to reschedule at my discretion. You are allowed to reschedule your appointment ONCE given 48+ hour notice. No shows will forfeit their booking fee and you will NOT be rebooked unless a new booking fee and 50% of missed service is paid.

3. ONE guest is allowed. Showing up with guests without informing me may result in your appointment being canceled and booking fee forfeited. If you are getting matching tattoos, DO NOT bring additional guests. I have a small treatment space and it is distracting/overwhelming to have too many people in my room.

4. Fine line tattoos may require a touch up due to their delicate nature. I offer one free touch up as long as it's within 6 months of your tattoo appointment. Touch ups can be performed a minimum of 4 weeks after the initial appointment. Any additional touch ups will require a fee. Failure to follow proper aftercare may result in unsavory healing/retention.

5. NO REFUNDS are given under any circumstance.

6. I reserve the right to refuse any client that is not appropriate for this procedure.

By signing below, you understand and agree with stated cancellation/reschedule policies.
I understand that special circumstances are unavoidable and it may be necessary to cancel your appointment. If you find yourself unable to keep your appointment, I request 48 hours notice. Failure to show will have a 50% service fee required to rebook. Cancellations OR rescheduled appointments with less than 48 hours notice, will lose their booking fee and require a new one to book in. Being over 15 minutes late for your appointment may require the need to reschedule at the artists discretion. If so, you will lose your booking fee, and will require a new one to rebook.

You are allowed to reschedule your appointment ONCE if given 48+ hour notice. More than once and your deposit will be forfeited and a new fee must be paid to rebook.

Sign below to acknowledge the above information