Appointment Request Form
This is a digital consultation form to determine if you are a candidate for the requested procedure. Upon assessing your suitability, you will be provided with the option to schedule either an in-person consultation or the actual treatment.
Full Name
*
First Name
Last Name
Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Who/what social media platform were you referred by?
*
Phiacademy Craft Master Carla Goycochea services by referral only.
What PMU procedure are you interested in?
*
Please Select
Scalp Micropigmentation
Microblading
Powderbrows
Combo Brows (Microblading & Powderbrows)
Nanobrows
Lipblush
PMU Brows - Not sure which treatment yet
Have you had any previous PMU procedure before?
*
Please Select
Yes
No
If yes, please state the type of procedure, what part of the face was treated and when was the last time you received the treatment?
PLEASE SUBMIT 3 CLEAR PHOTOS OF YOUR EYEBROWS A/O LIPS LIKE THE EXAMPLES BELOW. ALL UNDER GOOD LIGHTING.
*
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Please describe your skin type:
*
Normal
Normal to oily
Oily
Combination (T-zone)
Normal to dry
Dry
Acneic
Sensitive
Please describe what you would like to enhance on your scalp/eyebrows/lips?
*
Are you willing to wear the treated area (scalp/eyebrows/lips) darker than desired result for about one week?
*
Please Select
Yes
No
Do you use Retinol?
*
Please Select
Yes
No
Do you use tanning beds often?
*
Please Select
Yes
No
Are you currently pregnant or nursing?
*
Please Select
Yes
No
Do you understand that any PMU procedure requires at least two to three sessions to achieve desired results?
*
Please Select
Yes
No
Do agree to follow the main aftercare recommendations of avoiding: sun, pool, ocean, sauna and other invasive treatments for the first week?
*
Please Select
Yes
No
Do you agree to following Craft Master Carla's recommendations on the amount of sessions needed to accomplish desired results based on skin type and color?
*
Please Select
Yes
No
Do you agree to providing images as requested so that Craft Master Carla can provide a digital design of the style that would suit you best?
*
Please Select
Yes
No
Do you agree to this establishment 's No-Refund policy as desired result is previously approved following digital design?
*
Please Select
Yes
No
Please disclose all medical conditions, if applicable.
*
I understand that it will take from 24-72 hours to receive a response and/or digital design of the service requested and I hereby certify that all the information provided above is true and accurate.
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