PMB MODEL APPLICATION

APPLY HERE TO BE A PMB PROCEDURE MODEL...
Full Name*

First NameLast Name
E-mail*
Phone #*

Area CodePhone Number
AGE: *
Referred By:*
Please note full name if referred by Friend or Family. If found via websearch - please specify!
Please mark any/all that apply.

I am UNDER 18 years old.I have Oily SkinI am Allergic/Sensitive to LidocaineI am Allergic/Sensitive to LatexI have been pregnant in the last 12 monthsI am currently PregnantI am currently BreastfeedingI am undergoing Hormone Replacement TreatmentsI have a Thyroid conditionI frequent Tanning BedsI use exfoliating facial products dailyI wear contact lensesI use prescription skin care treatmentsI am taking blood thinning medicationI have a blood borne illnessI have uncontrolled high blood pressureI have had previous Permanent Makeup on the same area I am applying to be a model forI am DiabeticI currently have Lash Extensions and would not be willing to have them removed prior to a visitI am currently using eyelash enhancing serums, or I have in the last 6 monthsI have been on Accutane in the last 12 months.I am prone to getting cold sores/fever blisters/ herpes on my mouth or eyesOther
Please mark all statements as acknowledgement.

I understand that being a model means a student (under very close supervision) is providing my services.I am ok with a professional picking the style of brow that is best for my skin type, face shape, and preference. (Hairstrokes, Powder, or Combo Brow options available)I am ok with a professional picking the style of eyeliner that is best for my me.I understand that images of my service may be shared socially, and that full face images will also be used as necessary.I understand that procedures are done in a classroom setting with observers.
I am Interested in*

Eyeliner/Lash EnhancementBrowsLip BlushLash ExtensionsOther
I am Interested in*

Being a Student's Model for an upcoming classBeing an Instructor Demo for an upcoming class.Other
Please List ALL Medications, Vitamins, and Supplements you regularly take. Certain medications can affect the healing and/or procedure itself. Please Include all prescription and over the counter medications.
Please use this comment box to tell us about any items listed above that may need a short explanation. If you marked that you have had your permanent makeup previously done, please let us know how long ago, which procedure, and how much color remains.
Additional Comments
Please attach a BRIGHT,CLEAR, MAKEUP-FREE photo of the area(s) in which you are applying for. Please do not send blurry photos. It is typically best to have someone else take the photo for you. Full face image is ideal.*
Signature*

Clear
I have answered questions honestly and to the extent of my knowledge. I understand that not being forthright and honest with my medical history and background could negatively affect my procedure outcome. I agree to the policies of Permanent Makeup Boise, available to me at www.permanentmakeupboise.com . Clients who have had procedures performed by another technician will be charged the full price, according to the normal fee schedule, regardless of the procedure. We reserve the right to refuse any service or procedure.
When you've completed the form you can SUBMIT ONLINE by clicking "SUBMIT" below.
Your information will go directly to Permanent Makeup Boise. If needed, a technician will call you for additional information.

Completing this application does not guarantee you a model appointment. Not all applicants are suitable clients for a beginner or classroom setting. This does not necessarily mean you can never have permanent cosmetics with PMB in a normal appointment situation.
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APPLY HERE TO BE A PMB PROCEDURE MODEL...