Online Treatment Record

Let’s get started, babe.

Cosmetic Tattoo Treatment Record

PLEASE ONLY COMPLETE THIS FORM WITH YOUR ARTIST AT THE STUDIO.

You can complete an ONLINE CONSULTATION here. We usually get back to you within 24 hours.

Alternatively, you can BOOK an appointment with us here.

Before anything, as always we recommend if you haven’t read through the pre & post-care pages, please do so. It is vital to be aware of all information before commencing the treatment.

Pre – Care

After – Care

hello@beautycosmeticpma.com
0473 038 849

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Name(required)

Phone(required)

Age

Date of procedure(required)

Procedure?(required)

Ombre Brows Microbladed Brows Combination Brows Feather Stroke Brows Eyeliner Lip Blush Lip Line & Blend Scar Camouflage Micropigmentation Powder Brow Lash or Brow Lift

Pigment used(required)

Blades used(required)

Anesthesia used(required)

Is there an existing tattoo in the area to be treated?(required)

No Yes

Is it a touch-up?(required)

No Yes

Is it a cover-up?(required)

No Yes

Is removal needed?(required)

No Yes

ARE WE STARTING FRESH-FACED? (no previous cosmetic tattoos)(required)

No Yes

How often does the client wear makeup?(required)

Hardly ever Only at work Whenever I leave the house All the time

Are you pregnant or breastfeeding?(required)

No Yes

CURRENT BROW THICKNESS:

desired BROW THICKNESS:

Thin Thick Med Very Thick Not Sure

CURRENT BROW SHAPE:

desired BROW SHAPE:

STRAIGHT MEDIUM ARCH HIGH ARCH ROUNDED S-SHAPED Not sure

EYELINER SHAPE

EYELINER SHADE

EYELINER THICKNESS

Skin type?(required)

Hair colour?

Skin tone?(required)

Medical History

Have you had Botox/ Dysport or any fillers in the last three weeks(required)

No Yes

Are you allergic to Lidocaine, Prilocaine, Benzocaine, Tetracaineor Epinephrine?(required)

No Yes

Are you currently using products containing Retin-A orHyaluronic Acid (or similar ingredient)?(required)

No Yes

Check any that apply to you :(required)

Cold sores Diabetes Hep (A,B,C) Eczema/psoriasis Pregnant/nursing Heart conditions Taking blood thinners such as: Aspirin, Ibuprofen, Alcohol, Coumadin, etc None of the above

ARE YOU TAKING ANY MEDICATION? If yes, please list below.*(required)

DO YOU HAVE ANY ALLERGIES? IF SO, PLEASE LIST BELOW*(required)

Other medical issues or illnesses that should be declared?

Notes

Do you consent to the use of your media/photos from treatment on our social media and web pages?(required)

No Yes

Please select yes that the client has read and understood the information inputted in this form. They accept the responsibility to decide, all has been explained, desired colour, thickness, and shade for any procedures performed as agreed upon during the consultation. They agree that the information on this document is true and accurate.(required)

No Yes

Have you sent the square contract to the customer?(required)

No Yes

Client to write full name after reading the above

Do you agree the information given in this document is true and accurate(required)

No Yes

Do you consent to Esign this document via square?(required)

No Yes

SIGN

By submitting this information, it's agreed that the information on this form is true and accurate.

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