Name * First Name Last Name Date of Birth Gender * Female Male Other Age * Mobile Number * Email Address * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Occupation * Are you currently using any medications? * Yes No Are you able to use topical anesthetics? (lignocaine, tetracaine, prilocaine, epinepherine) * Yes No Do you have ANY allergies? * Yes No If so; please list all and any allergies. Are you pregnant, planning pregnancy or breastfeeding? * Yes No Do you have oily skin? * Yes No Have you had your lips or eyebrows tattooed before? * Yes No If so which area? Eyebrows Lips Do you have any health concerns? * Yes No Are you iron deficient or anemic? * Yes No Are you prone to keloid scarring? * Yes No Are you prone to cold sores? * Yes No Please take a FULL FACE, LEFT BROW & RIGHT BROW image (Eyebrow tattooing) or front on photo of your lips with no makeup (Lip tattooing) with sufficient lighting and send via email or text. Please select where you are sending the images. * Email - salon@archbrowaesthetics.com Text - 0493 982 327 I have thoroughly read and understood the information section and have answered each question truthfully * I Accept Thank you for your submission, a team member from Arch Brow Aesthetics will contact you in regards to cosmetic tattooing. COSMETIC TattooConsultationPlease ensure you answer all questions truthfully and to the best of your knowledge.
