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Check ALL that apply:
I am 18 years or older.
I am allergic/sensitive to Lidocaine
I am allergic/sensitive to latex.
I have been pregnant in the last 12 months.
I am currently pregnant.
I am currently breastfeeding.
I am undergoing Hormone Replacement.
I have a Thyroid condition.
I use tanning beds frequently.
I use exfoliating products daily.
I wear contact lenses.
I am prone to Cold Sores/Herpes/Fever Blisters.
I am taking blood thinning medications.
I have a Blood Borne Illness.
I have uncontrolled high blood pressure.
I have had previous permanent makeup.
I am Diabetic.
I am currently using eyelash enhancing serums, or have in the last 6 months.
I have been on Accutane in the last 12 months.
I have had shingles on my face.
I am interested in:
Please list all medications, vitamins, and supplements you regularly take. Include all prescription and over the counter medications. Certain medications, vitamins and supplements can affect healing or the procedure itself.
Please include a BRIGHT, CLEAR & MAKEUP FREE photo of your brows.
I have answered questions honestly and to the extent of my knowledge. I understand that not being honest with my medical history and background could negatively affect my procedure outcome. I agree to the policies of Alex Brown Esthetics available to me at www.alexbrownesthetics.com. Clients who have procedures done previously by another technician will be charged the full price of a New Procedure. We reserve the right to refuse any service or procedure.
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