PMU Consultation and Waiver Form

  • Client Consultation Form

  • Personal/Medical History Form

    In order to provide you with the most appropiate PMU treatment, we need you to complete the following questionnaire. All information is strictly confidential.

  • Date of Birth*
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • How did you hear about us?*
  • Do you or have you ever regularly sunbathed or used tanning salons?*
  • Do you smoke?*
  • Have you previously had micropigmentation performed on the exact area where I will be working on by another professional?*
  • Do you have any Botox or other injectables on the last 30 days?*
  • Are you currently under the care of a physician for management of an illness or condition?*
  • Rows
  • Do you have any other health problems or medical conditions not listed above?*
  • Have you ever had an allergic reaction to any food, drug or enviromental source?*
  • Are you pregnant or trying to become pregnant?*
  • Are you breastfeeding?*
  • Do you have a history of, or currently experience, epilepsy or seizures?*
  • Are you on any blood-thinning medications or immunosuppressive drugs, such as aspirin?*
  • Do you participate in outdoor recreational activities?*
  • Have you used Accutane or been treated for acne in the past year?*
  • Do you use skincare products with Retin-A, Retinols or Vitamin A?*
  • Do you have any known allergies to lidocaine, numbing agents, or pigments?*
  • Have you had any facial procedures done in the last 30 days?*
  • Have you had permanent makeup or other cosmetic tattoo procedures before?*
  • Have you had any recent medical procedures?*
  • Do you have any chronic medical conditions?*
  • Do you currently have any blemishes, cuts, irritation, or infections on the area to be treated?*
  • Do you have any moles, raised areas, prior or current piercings in the projected procedural area?*
  • Please check off your skin type:*

  • Please use chart below to determine your Fitzpatrick score, this helps us determine what pigment colours are best suited for you.

  • Image field 48
  • Please check off your Fitzpatrick score:*

  • AFTERCARE

  • PMU AFTERCARE INSTRUCTIONS

    Aftercare is essential for maintaining the appearance and longevity of your new eyebrows. Please read the following eyebrow aftercare instructions carefully, as they apply to all of our eyebrow treatments: Microblading, Powder Brows, and Combo Brows

  • EYEBROW AFTERCARE

    Do not let any water, lotion, soap, or makeup touch your eyebrows area during the first 7 days after your procedure.

    Please wash your face carefully around the eyebrow without getting water on the treated area. During the shower, keep your face away from the shower head or take a bath.

    Itching and flaking may appear during the first seven days post procedure. Avoid picking or scratching as it can pull off scabs prematurely and cause patchy results or scarring. However, experience has shown that by following these after-care instructions, these symptoms may quickly disappear.

    After four days, ensure your hands are completely clean before gently applying the post-care ointment with a cotton swab. This should be done twice a day, in the morning and at night, but use the ointment sparingly, as your skin needs to heal naturally. Continue applying the ointment for seven days.

    The following must be avoided during all 14 days post procedure:

    • Increased sweating
    • Practicing sports
    • Swimming
    • Sun tanning or salon tanning
    • Hot sauna, hot bath, or Jacuzzi
    • Exposure to UV/UVA Rays or chemicals as they have been known to cause a shift in color and premature fading
    • Any laser or chemical treatments or peelings, and/or any creams containing Retin-A or Glycolic acid on the treatment area
    • Picking, peeling, or scratching of the micro pigmented area in order to avoid scarring of the area or removal of the pigment
    • Performing tasks related to heavy household cleaning such as garage or basement cleaning where there is a lot of airborne debris
    • Avoid sleeping on your face: For the first 10 days, try not to sleep on your eyebrows to prevent unnecessary pressure and friction, which may interfere with the healing process
    • Avoid excessive facial expressions: Minimize exaggerated facial movements, especially during the first few days of healing. Excessive stretching or movement of the skin can affect healing and pigment retention
    • Be cautious with makeup: After the initial healing period (approximately two weeks), you may apply makeup around your eyebrows. However, avoid applying makeup directly to the treated area for at least 14 days to allow the skin to fully heal
    • Use a clean pillowcase: Change your pillowcase every 2–3 days to reduce the risk of bacteria or dirt coming into contact with your healing eyebrows
    • Avoid aggressive exfoliation: For at least 30 days post-procedure, avoid using exfoliating products or treatments on the brow area. This includes physical scrubs and products containing AHA/BHA, as they may cause premature fading or irritation
    • Stay hydrated: Proper hydration supports the body's natural healing process, so drink plenty of water during recovery
    • Drinking alcohol in excess, as it may lead to slow healing of wounds
    • Driving in open air vehicles such as convertibles, boats, bicycles, or motorcycles
    • Touching the eyebrow area except for when rinsing and applying the post-care cream with a cotton swab
    • Inform your nurse before giving blood, as the procedure may affect donation eligibility

      Inform your therapist before a chemical peel or other medical procedure, as these should only be done after the healing process is complete.

      Contact a physician if any signs or symptoms develop such as the following: fever, redness at the site, swelling, tenderness of the procedure site, elevated body temperature, red streaks going from the procedure site towards the heart, and/or any green/yellow discharge that is foul in odor.

  • WHAT TO EXPECT DURING AND AFTER YOUR EYEBROW SESSION

    The entire healing process will take from 4-6 weeks depending on your body regeneration and age. Your new eyebrows will go through several phases during the healing cycle.

    The pigment will appear very unnatural looking immediately after the procedure. The color of the pigment will appear much darker the next day.

    Note that because of natural skin regeneration, after recovery period (peeling), brows might appear lighter than the original. This might give you the impression that color is fading too quickly. Often, even with proper care, clients may have more fading in some areas which make the brows look uneven. It is absolutely normal. That's the reason why most clients need a touchup after 6 weeks.

    Once the healing of the skin starts taking place, it will look like dandruff flakes or dry skin. However, this is just superficial color and dry skin being naturally removed from your eyebrows. The final look of your eyebrows will be apparent approximately 30 days after your procedure.

    Never rub the treated area as it will disturb the skin from natural healing.

    Once completely healed, always apply a layer of sunscreen SPF 30 up to SPF 50 on your eyebrows when exposed to the sun. Sun exposure might cause the color pigment to fade away more quickly.

    When using foundation, avoid the area of your healed eyebrows. If foundation covers healed brows, your eyebrows will appear lighter.

    You can now enjoy your beautiful new eyebrows. You will simply love your new gorgeous fresh look!

  • HEALING PROCESS

    RIGHT AFTER - Brows appear bold and have redness as well, the intensity of redness can vary for each individual. They may feel tender and appear uneven. Keep them clean and dry, do not touch your eyebrows!

    DAY 3 - Brows will start developing a layer of scab, continue keeping your brows dry and clean.

    DAY 4 - The scab is starting to feel thigh and itchy, start applying a light layer of ointment. Apply a rice grain amount of aftercare ointment (Aquaphor) on each eyebrow with a cotton swab and clean hands, spread a VERY THIN layer of the ointment across the treated area every morning and night. Brows should not appear greasy, glossy or shiny, if so you used too much, as this can suffocate the skin and delay healing. Never apply ointment on wet or damp tattoos. Continue ointment until your brows are no longer scabbing.

    DAY 7 - The beginning stages of scabs peeling off, do not touch scabs! Avoid picking or scratching as it can pull off scabs prematurely and cause patchy results or scarring.

    DAY 12 - Scabs are done peeling, brows look light after peeling process. The lightness can vary for each individual

    DAY 14 - Brows are safe from water. Clients may return to normal skincare routines. Brows will appear very light, after scabs come off, every week up to 6 weeks color will continue to surface and brows will get darker.

    DAY 40 - At this stage the color of brows is complete and all redness is gone. Brows have fully healed. Now enjoy them!

    For some clients they need a touch-up to make any needed adjustments.

  • ACKNOWLEDGMENT

  • Please read each statement carefully. By checking each box, you confirm that you understand and agree to the statement.

  • I,       confirm that I am over 18 years of age, not under the influence of drugs or alcohol, and not pregnant or nursing. I voluntarily wish to receive the semi-permanent makeup (PMU) procedure.

    • Sun Damaged Skin will always heal cool and may not be able to be warmed up regardless of color chosen.
    • Use of products with alpha-hydroxy acids (AHA), glycolic acids or retinol etc will cause the pigment to fade faster even if not applied directly to the treated area.
  • Date*
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