Please answer all questions to the best of your knowledge. Failure to disclose any information could impact the healed results of your permanent make up. Not everyone is suitable for permanent make up. If you withhold any information you may be declined treatment on the day and will loose your deposit. When you have completed the form we can advise you of the best time to schedule your appointment for optimal results. 

Name
Name
Have you ever had any previous permanent make up procedures or microblading done? (even if it has completely faded|)
Are you currently taking any blood thinning medications i.e. Warfarin / Aspirin?
Have you sunbathed / used sunbeds / been on holiday in the last 30 days or do you currently have a tan?
Do you have any holidays planned over the next 12 weeks?
Do you regularly work out (5+ times per week)?
Do you spend a lot of time in the sun / frequently use sunbeds?
Do you have any Scars or Moles on or near the brow area?
Do you use / have you used Retin A or glycolic skin care products in the last 6 weeks?
Have you used hydrocortisone / topical steroid creams in the last 6 weeks?
Is you skin excessively oily or do you have large pores on the forehead?
Have you ever had or are you planning to have a chemical / laser peel?
Please provide date of last peel.
Have you ever had or are you planning to have botox / fillers near the brow area?
Please provide dates
Are you / Have you ever been on Roaccutane / Isotretinoin medication?
If yes please provide dates
Do you / have you ever suffered from hair loss / Alopecia?
Are you pregnant or breastfeeding?
Have you ever been prescribed antibiotics prior to any medical procedures?
Do you take any anti inflammatory medications or steroids?
Have you undergone Chemotherapy / radiotherapy in the last 6 months?
Do you suffer from any thyroid disorders?
Do you suffer from any health conditions?
Please provide details below.
Do you suffer from any allergies?
Please provide details below.
Have you ever taken a reaction to topical numbing creams or a dental anaesthetic?
Have you taken/been prescribed any medications over the last 6 months?
Please provide details below.