Permanent Makeup Consultation Form
@sabs.tattoos | houston, texas 77077 🩷
Name
*
First Name
Last Name
Pronouns
*
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is your preferred method of contact?
*
Please Select
text
email
Procedure/Service
*
Microblading (CASE BY CASE)
Ombré/Powder Brows
Lip Blushing
Eyeliner/Lash Enhancement
Faux Freckles
Coverup (CASE BY CASE, if you have had your service done by someone other than me, it is a coverup NOT a touch up)
Please explain in depth what cosmetic service you are interested in getting. Tell me what your desired results are, any concerns and any questions you may have for me!
*
Choose a preferred appointment date and time
*
Are you currently taking any medications?
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Yes
No
If yes, what are the medications you're currently taking and what is their purpose? (If none, put NA)
Do you have any allergies?
*
Yes
No
Please list down your allergies below (e.g. seafood allergy, penicillin-based antibiotic allergies)
Are you pregnant?
*
Yes
No
Are you breastfeeding?
*
Yes
No
Are you wearing contact lenses? (For eyeliner clients only)
Yes
No
Have you had any Botox or other injectables in the last 14 days?
Yes
No
Are you using any medical skincare like retinol or accutane?
*
Yes
No
Do you participate in outdoor recreational activities or regular gym schedule?
*
Yes
No
If yes, please explain these routines in as much detail as possible!
Please check below if you have the following medical condition:
*
Rows
Yes
No
Remarks
Cancer
Hyperpigmentation
Keloid
Hemophilia
Diabetes
Hepatitis
Tuberculosis
Epilepsy
Anemia
HIV positive
Cancer
Venereal Disease
Asthma
Iron Deficiency Anemia
Radiation therapy or chemotherapy
Eye Disorder
Skin Disorder
Herpes Simplex
Alopecia
Please upload at least 2 photos of your face, one of your full face and one up close of the area you are looking to get permanent makeup on. Please make sure you are doing this in clear, good lighting. If there is a specific way you’d like them to look based on your everyday makeup, please upload that. If you don’t have that, please upload at least one reference photo of how you would like your permanent makeup to look.
*
Browse Files
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Have you had any permanent makeup on the area you are inquiring for before?
*
Yes
No
When did you have it? (If you don’t know the exact date, please pick an approximate date)
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How did you hear about us?
*
Facebook
Tiktok
Twitter
Instagram
Online Ads
Posters/Banners
Referral
Other
Acknowledgment
*
I understand that this procedure cannot guarantee 100% expected results.
I understand that my artist will advise what’s best for my service based on my needs as well as facial structure.
I release the center for any liabilities related to the treatment and result specifically allergic reactions and applied pigmentation.
I understand that I need to follow the instructions in terms of pre-procedure and post-procedure for the best results.
I understand that permanent cosmetics are a form of tattooing.
I understand that this procedure might be slightly uncomfortable.
I understand that if I do this procedure, I might experience infection, minor bleeding, swelling, and redness.
I understand that if I choose to book, I am required to put down a $50-$200 deposit within 24 hours to secure an appointment.
I understand deposits are non-refundable.
I confirm that I have read, understand, and answered this consultation form accurately to the best of my knowledge.
Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
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