Permanent Make-up Services Inquiry Form

Curating Confidence, One Service at a Time!

Kindly fill out the entire form so we can ensure you are an ideal candidate and customize the perfect brow service for your unique features!
Permanent Makeup

Let’s work together to create your personalized, beautifully shaped brows that are designed to last and enhance your natural features!
Name

First NameLast Name
Birthday

MonthDayYear
Date
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
CONTRAINDICATIONS

Contraindications for all procedures: • Those under the age of 18 years of age • Pregnancy/ Nursing/ Lactating • HIV. Hepatitis B or C or any blood borne pathogendisease • Glaucoma & Diabetes Type 1 (must have doctors consent note) • Lupus, Active Vitiligo • Active Skin Disorders: Cold Sores, Shingles, Impetigo, Psoriasis, Pink Eye, Sunburn, Severe Acne, Staphinfections, MRSA, Severe Rosacea • Blood Disorder: Sickle Cell, Hemophilia • History of Keloids Formation • Undergoing cancer treatment (doctor's note required)• Accutane (must be off for at least 6 months).
Are you a Good Candidate

Please check off any of the conditions.
Do you have any of the following conditions?
What would you like to enhance or alter about your eyebrows?
How did you hear about us? Did someone refer you to us?
Our current pricing is $375 for Powder Brows and $500 for Combo Brows. To secure your appointment, a $100 non-refundable retainer is required at the time of booking. This can be sent via Zelle, Venmo, or CashApp once we confirm your appointment date. Would you like to proceed?
NON-REFUNDABLE RETAINER FEE POLICY

A non-refundable retainer fee is required to secure your appointment and will be applied to your total service price. This fee will NOT be refunded under ANY circumstances, including cancellations, reschedules, or no-shows. By paying, you waive all rights to disputes or chargebacks. Any chargeback attempt will be contested with proof of this agreement. The remaining balance is due on the day of your appointment. We accept Cash, Zelle, Venmo, PayPal, and Cash App.
Please upload a photo of your natural brows (no makeup). For the best accuracy, take the photo in clear lighting such as in front of a ring light, near a window, or outdoors in daylight. Please do not crop, filter, or edit the image. A clear, natural photo allows me to properly assess your brow structure and design the most flattering, customized shape for you!

Cancelof
Authorization
I acknowledge that this form serves as an inquiry for Permanent Makeup services with Vasela Bella, for any and all permanent makeup services, specifically for Combo Brows or Powder/Ombre Brows. I confirm that I have carefully reviewed the Non-Refundable Retainer Policy and the list of Contraindications, and that all information I have provided is truthful and accurate. By submitting this form, I agree to all terms and conditions stated above.
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Curating Confidence, One Service at a Time!

Permanent Makeup

CONTRAINDICATIONS

Are you a Good Candidate

NON-REFUNDABLE RETAINER FEE POLICY

Authorization