Consultation Form

Consultation Form
Please answer all the questions below so I can determine if the treatment is suitable for you you. Once submitted I will review and will be in touch within 24hrs.

Please take a good look at the skin under your eyebrow hair. If the skin is red or dry or has small red or white bumps or visible blood vessels then please indicate that in the form below. It's very important as you may not be suitable for the treatment!
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Age
What are your goals and expectations of the treatment?*
Have you previously had Microblading, Powder Brows or eyebrow tattoo?*

YesNo
What skin type do you have?*

OilyDryNormalSensitiveSun DamagedBleeds easily
Do you have any of the following skin conditions on your face, specifically on the brow area. Please take a good look at the skin under your eyebrow hair before answering this question.

Eczema (red itchy skin),Rosacea (red skin/visible blood vessels),Psoriasis (small rough to the touch red bumps in places where the hairs come out of the skin),Acne (whiteheads/blackheads or pimples),Dermatitis (itchy dry skin or a rash)
Are you currently using medication or cream to treat Acne?*

YesNo
Do you have any allergies to metals or cosmetics or hair dye?

YesNo
Confirm you're not pregnant/breastfeeding, and take no medication/have any medical conditions.*

I confirm the above
Signed

Clear
Date

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Date
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