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Cosmetic Brow Tattooing Intake Form

Personal Information

Would you like to be added to our emaill list for specials and discounts?
Please mark any of the following conditions you may currently have.
Have you ever had a cosmetic tattoo or cosmetic procedure before?
Have you ever had any adverse reactions to any previous treatments?
Do you have moles/raised areas in or around the treatment area?
Do you have or have you ever had a piecing in treatment area?
Are you currently wearing lash extensions of any kind?
Are you taking any medications or vitamins, including over-the-counter prescription drugs?
Have you had Botox, Restylane or Collagen injections?
Within last nine months, have you undergone any surgery or plastic surgery?
Have you ever had a cold sore/fever blisters?
Have you ever had an allergic reaction to any of the following?
Do you scar easily?
Do you bruise/bleed easily?
Are you taking birth control?
Are you pregnant or trying to become pregnant?
Are you undergoing any hormone replacement therapy?

Please check the required areas are complete

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