Name * First Name Last Name Email * Address * When did you last get your eyebrows done? * Bithdate Phone Number * Emergency Contact Number History of MRSA Yes No Diabetes Yes No Herpes Infection on the procedure site Yes No Hepatitis (A, B, C,D) Yes No Bleeding Disorder Yes No Allergic Reaction to Latex Yes No Abnormal Heart Condition Yes No Chemical Peel (Laser Treatment) Yes No Currently Pregnant/Breastfeeding Yes No Cancer? If so, what year? Yes No Chemotherapy/Radiation Yes No Tumors/Growths/Cysts Yes No Allergic Reactions to Antibiotics Yes No Botox Yes No Lips Fillers/Restylane/Juvederm Yes No Forehead/Brow Lift Yes No Hemophilia Yes No Eye Surgery/Injury Yes No Contact Lenses (Currently) Yes No Brow/Lash Tinting Yes No Cardiac Valve Disease Yes No Accutane/Acne Treatment Yes No Tan (Booth or Sun) Yes No Difficulty Numbing with Dental Work Yes No Taking Blood Thinners (ie., Aspirin, Ibuprofen, Alcohol, Coumadin, etc.,) Yes No Do you have any history of medication use or are you currently using medication, included prescribed antibiotics prior to dental or surgical procedures? Yes No Allergic reactions to any medications? (ie., Lidocaine, Epinephrine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylene Glycol, and etc.,) Yes No Do you use skincare products containing; Retin-A, Glycolic Acid or Alpha Hydroxyl? Yes No Any diseases or disorders not listed? Please inform the professionals. Yes No I agree that all the information above is true and accurate to the best of my knowledge. Yes NO WAIVER Hello gorgeous, Your progress and well-being are significant to me. Following the recommended aftercare routine is essential to achieving the best results. I've noticed some challenges adhering to this routine and want to address this for transparency. This form ensures you understand the importance of aftercare, outlining our responsibilities and expectations. "We are so excited to feature your incredible before-and-after photos on all our social media platforms! Rest assured, we will only share the images and will not include any personal details. Please let us know if you're comfortable with this or have any questions. We can't wait to showcase your amazing transformation!" Please indicate your preference for sharing your before-and-after pictures on our social media platforms by providing an answer below. By answering, you acknowledge that not following aftercare may affect results. I cannot be held responsible for any variations. I am here to answer any questions you may have. Please answer below to acknowledge your understanding and agreement to these terms. Thank you for providing your information! This helps us understand your needs better and ensures that we can offer the best possible service tailored just for you. If you have any questions or need further assistance, feel free to reach out at any time. We've already sent you the pre- and Post-Care instructions via email or text. If you'd like to see them again, click HERE.