Name *

First Name

Last Name

Date of birth *

MM

DD

YYYY

Phone *

(###)

###

####

Are you pregnant or breastfeeding? *

Yes

No

Are you currently taking any medications? *

Yes

No

Do you have any allergies? *

Yes

No

Have you had your eyebrows tattooed before? *

Yes

No

Do you have any health concerns? *

Yes

No

Are you prone to keloid scarring? *

Yes

No

Are you currently using any active skincare? *

Vitamin A/Retinol, AHAs (Glycolic acid, lactic acids etc, or BHAs (Salicylic acid)

Yes

No

I have read and understood the information provided on the 'Eyebrow Tattoo' page and have answered each question truthfully. *

I accept