Client History Form

Please fill out our online client history form prior to your appointment to save time. You may also fill it out in our office if you feel more comfortable or have any questions. Your information will be kept private and will not be shared.
 
Thank you, we look forward to seeing you.

  1. Full Name(*)
    Please enter your Full Name
  2. Date of Birth(*)
    Please enter your Date of Birth
    (mm-dd-yyyy)
  3. Gender(*)
    Please select your Gender
  4. Address
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  5. City(*)
    Please enter your City
  6. State(*)
    Please select your State
  7. Zip(*)
    Please enter your Zip
  8. Email(*)
    Please enter a valid Email Address
  9. Phone
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  10. Emergency Contact(*)
    Please enter an Emergency Contact Person
  11. Emergency Contact Phone(*)
    Please enter an Emergency Contact Phone Number
  12. How did you hear about us?
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  13. Medical History Information (check any that apply)(*)
    Please Select the Appropriate Options
  14. If you answered "YES" to any question above, use the space below to provide an explanation. Correlate your explanation to a specific question number. A "yes" answer does not indicate you are not an acceptable candidate for permanent cosmetics. It may simply be information that is valuable to me as your technician as each person's body is unique, or it may indicate that based on any health conditions that affect healing, it would be advisable or required for you to consult with your physician before proceeding. If this form has not addressed a medical condition you have, please list it below.
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  15. (*)

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  16. Client Signature(*)
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  17. Date(*)
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  18. Please enter the code(*)
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  19.   

How we guarantee

you’ll love your Beautifulook


Our steps to ensure that you'll Love the Results

We begin with taking precise measurements and drawing on your makeup with an erasable pencil and only proceeding after your approval.

Then we apply your custom mixed pigments in precise layers, and you are able to check the work in progress to ensure you get the look that you want.

Finally, after 4 weeks you come back for you Perfection Visit, which is included in the price. This is where you can make changes if you wish to get the final results that you desire.

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our services

PRIVATE CONSULTATION

Reserve your FREE personal consultation to discuss your desired Permanent Cosmetic Procedure

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