Brittany's Brows | New Client Consultation Form

First name

Last name

Email

Phone

Address

Date of Birth

Day

Month

Year

Gender

Occupation

Are you currently using any medications?

Yes

No

If yes, please list them:

Do you have any allergies?

Yes

No

If yes, please list them:

Do you have oily skin?

Yes

No

I don't know

Have you ever had your eyebrows tattooed before?

Yes

No

Please tick any that apply to you

Are you prone to keloid scarring?

Yes

No

Do you have any health concerns?

Yes

No

If yes, please provide detail:

Are you able to use topical anaesthetics?

Yes

No

Under our current legislation, we are unable to provide topical anaesthetics. Do you agree to provide your own topical anaesthetic?

Yes

No

Please email the following photos to brittany.mitchell21@hotmail.com. Ensure photos are taken with good, natural lighting and no filters or makeup is present.

Full Face

Left Eyebrow

Right Eyebrow

I acknowledge and agree that I have answered all the above questions truthfully.