Thank you for your interest in BrowBaeby Cosmetic Tattoo. Please take a moment to review this form to qualify you to receive PMU services. This form also includes an overview of our Policies & Procedures to begin the scheduling process. This form must be filled out and submitted prior to securing an appointment date. THANK YOU!

Full Name *

Phone *

Email *

What service are you wanting to schedule?? *

visit www.BrowBaeby.com (Q&A tab) for more detailed information on all PMU services

Are you pregnant or nursing? (PMU services cannot be done at this time) *

Yes

Are you taking any medications? Blood thinners? *

Yes

What medications, how much, what for?

Medications & medical issues can affect the bodies ability to retain pigment and heal properly. It is imperative that you list any and all medications/medical issues.

Have you had Cosmetic Surgery or other cosmetic procedures? (botox, fillers, other PMU services ... etc) *

Yes

When & What?

Have you ever been on Accutane in the last year? (Accutane must be discontinued at least 1-year before any PMU service) *

Yes

Do you have existing permanent makeup? *

Yes

What procedure was done & how long ago did you have your Permanent Makeup service done?

SCHEDULE & SALON POLICY:

I have read and agree to SCHEDULE & SALON POLICY: *

CONSENT AND RELEASE AGREEMENT FOR PERMANENT COSMETICS

I have read and agree CONSENT AND RELEASE AGREEMENT FOR PERMANENT COSMETICS *

I understand that Cosmetic Tattoo Services such as Powder Brows, Lash-liner and Lip Blush may require more than one treatment to achieve the best results. Typically a touch-up session is needed. Can be scheduled 6weeks after initial session and is an additional charge . *

I will strictly adhere to pre and post-procedure instructions. I understand that my failure to do so may jeopardize my chances for a successful procedure. If I am on any medication for depression or any other mood-altering prescription, I will advise my technician. If I have ever had cold sores, I will consult with and strictly follow my doctor’s instructions before contemplating any permanent cosmetic procedure around my lips. *

POSSIBLE RISKS, HAZARDS, OR COMPLICATIONS

I have read and agree to POSSIBLE RISKS, HAZARDS, OR COMPLICATIONS *

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I have been informed of the nature, risks, and possible complications, and consequences of permanent and semi-permanent skin pigmentation. (Initial below) *

I confirm I am over the age of 18. I am not under the influence of drugs or alcohol. I am not pregnant or nursing. I do not have any medical, mental or physical impairment that might effect my well being as a direct or indirect result of my decision to have services done at this time. (Initial below) *

Is there anything you would like to add that wasnt listed above? Anything you would like your PMU artist to be aware of?