ONLINE CONSULTATION Name * First Name Last Name Date of Birth * MM DD YYYY Mobile Number * (###) ### #### Email * Address * Have you previously had your eyebrows tattooed? * Yes No Are you able to use topical anaesthetic? * Yes No Are you pregnant or breastfeeding? * Yes No Are you prone to keloid scarring? * Yes No Do you have any major health or skin concerns? * If yes, please specify. Are you currently using any medication? * If yes, please specify. Do you have ANY allergies? * If yes, please specify. I have thoroughly read and understood the information provided to me above in the 'information pack' and have answered each question truthfully* * I Agree Thank you!
