New Client Consultation Form
General Info
Are you a new or returning client?
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New Client
Returning Client
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
IG Handle
@IGhandle
Occupation
Optional
How did you find my work?
*
Facebook
Google Search
Instagram
Pinterest
TikTok
Word of mouth
Other
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Procedure Information
Which procedure are you interested in booking?
Please Select
Nano Brows
Powder Brows
Combination Brows
Brows - unsure which service
Eyebrow Touch Up From Another Artist
Lip Blush Tattoo
Eyeliner or Lash Enhancement
3D Areola Restoration
Will this be your first time getting this procedure? If not, please elaborate.
*
Please note that Shaneen takes correction, cover up, or previous work for touch ups on a case by case basis. Standard rates apply, as Touch Up pricing is reserved for current clientele only.
What is your skin type?
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Oily (larger pores, shiny throughout the day)
Normal/Dry (small to no pores)
Combination (oily in some areas, normal/dry in others)
Please upload one or two reference pictures of yourself e.g. eyebrows, eyelids, lips, areolas. No makeup/filters and, if possible, in natural light.
*
Browse Files
Drag and drop files here
Choose a file
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Please upload an inspiration photo of the look you'd like to achieve. Feel free to use Shaneen's work!
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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Health Information
Check any of the following conditions or medications that apply.
*
None
Accutane
Antibiotics
Bell’s Palsy
Blood Thinners (prescribed by a doctor, not aspirin)
Botox in the past 2 months
Exfoliants (retin-A, glycolic acid, vitamin c, etc.)
Heart Valve Replacement
Hemophilia
If you require pre-medication for dental procedures
Insulin Dependent Diabetes
Joint Replacement
Long Term Steroids
Lupus
Nursing
Organ transplant
Pacemaker
Pregnant or Breastfeeding
Receiving Chemotherapy or Radiation
Screws
Seizures
Stents
Steroids (long-term)
Tanning Beds
Titanium Rods
Under the age of 18
Active dermatologic disorders ie. Rosacea, Eczema, Psoriasis, Shingles, Active HSV anywhere on the face
If so, please specify which dermatological disorder
Please list all prescription medications you are currently taken or have taken in the last 6 months.
*
Do you have other medical conditions or anything else you think we should know?
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