Pre-Client Questionnaire

Name *
Name
Date
Date
Phone
Phone
Have you ever had any permanent makeup in the past on the area you're requesting by another technician?
Are you Pregnant, nursing, or trying to get pregnant within the last 6 months?
Any scars in the area you wish to have permanent makeup?
Blepharitis - Inflammation of the Eyelids or any other disorders affecting the eyelid area?
Have you ever had any eye surgeries?
Do you use Lash Growth Products? You will need to be off an entire month, before and after Permanent Makeup eyeliner procedures.
Do you wear false lashes? They must be removed prior to any Permanent Makeup eyeliner procedures.
Have you tinted your eye brows or eyelashes in the last few weeks?
Heart Conditions/Pace Maker/Defibrillator?
Shingles - Have you EVER had shingles on your face?
Eczema, Psoriasis, Chronic Reddened Area or Dermatitis?
Do you have Hepatitis?
Oily or severely oily skin?
Hemophilia-Bleeding Disorder - a rare bleeding disorder in which the blood doesn’t clot normally?
Deep wrinkles in the brow area?
Do you use Botox and or fillers?
Have you had a chemical peel and or laser treatment?
Cancer treatments?
Do you have Diabetes?
Thyroid condition and taking medication for this condition?
Hypo, Hyper Thyroidism, Graves Disease, Hashimotos?
Rosacea?
Moles/raised areas in or around the desired area?
Piercing in the brow/lip area - Scars can cause the pigment to migrate or blur.
On Accutane - acne medicine within the last year?
There are 6 skin types. Choose the one which best describes your skin type in the winter.
Auto Immune Disorder of any kind (MS, RA, Lupus or the like)?
MRSA - (can be very contagious) Have you ever had it?
Extremely Thin skin - Transparent or Translucent or very vascular?
Difficulty numbing with dental work?
Do you exercise on a regular basis?
Do you frequent hot tubs, saunas and or steam rooms?
Do you tan by booth or sun?
Have you ever had a cold sore or fever blisters?
Do you have any allergies?
After you have answered all of the questions above, please click the Submit button to send your completed questionnaire.