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What’s your first name?
What’s your last name?
What’s your email address?
What’s your phone number?
Are you an existing client?
Are you an existing client?
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Which treatment are you wanting?
Which treatment are you wanting?
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Do you have any previous cosmetic tattoo? If so, please provide details: Area the tattoo is on and how old it is.
Please list all medication you have taken in the past 12 months, including over the counter medications, prescription medications, pain killers and natural supplements
Please list all known allergies, eg. Latex, Nickel
Please list all medical conditions, mental and physical injuries recently or in the past eg. Diabetes, High Blood Pressure etc
Please list all cosmetic enhancements you have undergone in the past 12 months. eg. Botox, Fillers, Peels, Cosmetic Surgery
Please list all active skincare used. eg. Vitamin A serum, Lactic Acid. If you are unsure just let us know what brands you are using
Please tick all that applies to your skin
Sun Damage
Acne
Rosacea
Open Pores
Dermatitis/Ezcema
Scarring
Excess sweating/Hot flushes
Thin Skin
Bumpy or flaking skin in eyebrows
Uneven skin texture
Age spots
Please tick your skn type
Very Oily
Oily
Combination
Normal
Dry
Very dry
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