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Makeup Artist / Microblading Artist
Portfolio
Bridal
Beauty
Microblading
About
Before & After
Client Testimonials
Client Record Form
About Me
Contact Me
Blog
Client Record Form
Name
*
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone Number
*
without spaces or extra characters
Email Address
*
Have you undergone any microdermabrasion or peeling treatments in the last 4 weeks?
*
Select
Yes
No
Have you had botox injections in the last 2 weeks?
*
Select
Yes
No
Have you had any eye problems in the last 4 weeks?
*
Select
Yes
No
Do you use any products containing AHA or retinol?
*
Select
Yes
No
Do you suffer from diabetes, hemophilia, HIV or hepatitis?
*
Select
Yes
No
Do you have any difficulties with anesthesia?
*
Select
Yes
No
Are you pregnant or nursing?
*
Select
Yes
No
Do you suffer from allergies?
*
Select
Yes
No
If yes, please explain:
Do you take blood-thinning medications?
*
Select
Yes
No
If yes, please provide the names of medications.
Comments
By submitting this form I confirm that all the information that I have provided above is correct. I also acknowledge having been informed that the microblading treatment is carried out under strict hygiene conditions. All reusable material is sterilized after each treatment, and all single-use material is disposed of in containers provided for this purpose. I have been informed that the microblading treatment may last approximately 2 hours. Since the pigment will come into contact with my skin, I consent to undergoing the required allergy test. I agree to allow my technician to intervene in case of any irritation following the treatment and to contact her should there be any complications. I consent to not holding my technician responsible for any post-treatment complications caused by either my non-observance of the specific home care instructions or any reaction following the use of pharmaceutical products that my technician has not pre-authorized.
*
I agree
Thank you!
