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FILL OUT THE FORM BELOW AND SOMEONE WILL BE IN TOUCH

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?

Message

Which treatment are you wanting?

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 * Required

Very Oily

Oily

Combination

Normal

Dry

Very dry

Address

7/37 Moore Street, Howick

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