Consultation Eligibility Form

Consultation Eligibility Form

Answer a few questions to confirm you’re a suitable candidate for lip blush services.
Are you 18+
What treatment are you interested in?
Do you currently have any previous pigment remaining in your lips?
Are you currently using any active skincare products?e.g. retinol, vitamin C, AHA/BHA or exfoliating acidsIf yes, please put them below.
Are you currently pregnant or breastfeeding? (Or have been in the last 6 months)
Do you have any allergies to pigments, makeup, or topical anesthetics?
Do you have any of the following conditions? (Select all that apply)
Have you had any cosmetic procedures on your lips in the past 6 months?
Are you currently taking any blood-thinning medications (e.g., aspirin, warfarin)?
Please describe any relevant medical conditions, allergies, or medications not listed above.
Full Name

First NameLast Name
Email Address
example@example.com
Please upload 2–3 clear, unfiltered photos of your lips in natural lighting.”Front-facing lips, relaxedLips slightly partedOne close-up

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I confirm that the information I have provided is accurate and complete. I understand that completing this consultation form does not guarantee that I am suitable for treatment and that my suitability will be assessed before I am permitted to book.
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