ONLINE CONSULTATION FORM

Before booking, I’d like to make sure cosmetic tattooing is suitable for you.

Please complete the short form below with any relevant health, medical or treatment information. I’ll review your answers personally and let you know if there’s anything we need to consider before going ahead.

First Name

Last Name

Phone

Suburb

Which services are you interested in to book? * Required

LIP BLUSH

BROWS

EYELINERS

Have you had a cold sore before? * Required

Yes

If you have a history of cold sores, ask your Doctor for a Prescription for Zovirax, Famvir, Valtrex or similar tablets – the daily dosage must be 1000mg in total. You should start taking the tablets a day before the Lip Treatment, continuing for 4 days.

Have you had your brows/lips/eyeliners tattooed before? * Required

Yes

If yes, where, when, and how many times?

Do you have health concerns? * Required

Yes

If yes, please list all and any health concerns you have now or have had in the past

Are you currently using any medications? * Required

Yes

Please list all medications you are on

Do you suffer from keloid scarring? * Required

Yes

If yes, attach a clear imge of your keloid scar

Upload File

Upload supported file (Max 15MB)

Have you been on accutaine treatment before? * Required

Yes

If yes, when and for how long?

Do you have any skin conditions? * Required

Eczema

Chronic Acne

Psoriasis

Keratosis pilaris

Dermatitis

Other

Are you currently using any of the following on or around the treatment area? Please select all that apply. * Required

Retinol or retinoids (e.g. tretinoin)

Exfoliating acids or peeling products (e.g. AHA/BHA)

Acne treatments (e.g. benzoyl peroxide)

Pigmentation or skin-lightening treatments (e.g. hydroquinone)

Prescription creams or topical medications

Eyebrow or eyelash growth serums

None of the above

Please add any additional information that we should know about you

Attach a clear image of the area you wish to have them treated with no make-up on. (This must be taken with sufficient lighting) (Max 15MB)

Upload File

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I confirm that the information given in this form is true

Thanks for submitting!

Please allow time for the form to submit until you receive confirmation

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