Fill this form if you are a new client or if it has been more than 2 years since you have been in. Please fill out this document for new procedures. Please enable JavaScript in your browser to complete this form.Name *FirstLastAgePhoneEmail *Services *lipseyelinereyebowsbreast repigmentationscar camoscalp micropigmantationBB Glowremoval/correctionDetails you want to add about the services you checked above:Do you have pre-existing permanent makeup we will be working on or correcting you received by another provider? *noyesHow many times have you had permanent makeup, microblading applied including touch ups? File Upload: Upload a photo of the pre-existing tattoo/permanent makeup. If you did a virtual consultation, you can skip this upload. Click or drag a file to this area to upload. Are you taking anticoagulants or blood thinners? *noyesAre you allergic to anesthetic? Anesthetics are numbing agents. *noyesWe use lidocaine and benzocaine. Proper numbing is essential for client comfort and excellent results.Check all that apply:In the sun a lotI use Retin AI have oily skinI have dry skinI have healthy normal skinI bruise easily I have very thin skinsmokedaily alcohol intake I have gotten a cold sore on my lips one or more times in my life. *noyes Permanent makeup does not cause cold sores. Cold sores are a herpes virus that a client already carries. 42% of the population carries the virus. Many clients take an oral perscription anti-viral like Valtrax for several days before the procedure to prevent an outbreak. Irritation from the procedure may wake the virus during the healing process. A medication to prevent an outbreak during the healing process is not required but many clients find the healing process to be more comfortable if they are not dealing with a cold sore. I understandBefore administering permanent cosmetics, cosmetic tattoo or microblading, a cautionary notice must be furnished to the recipient by the providing facility according to Southern Nevada Health District. All permanent cosmetic tattoo services should be considered permanent in nature and never be referred to as semi-permanent even though they fade in time. They must be removed if removal is desired by with tattoo removal techniques if the recipient no longer desires the pigment. However rare complications may be, the recipients must be informed that there may be bruising, swelling, scaring, discomfort, infection, hyperpigmentation, hypopigmentation, migration, allergic reaction or specifically with eyeliner procedures, corneal abrasion. The practice of tattoo and permanent makeup is not an exact science but an art and there are no refunds on procedures. *agreeThere is a 48-hour cancelation policy. You must cancel or reschedule on line at least 48 hours prior to your scheduled appointment. A no show or cancelation fee equal to 50% of your procedure service fee will be charged on all no shows and last minute cancelations that are not canceled per our policy. If the appointment is for a promotional free touch up and the appointment is no showed/cancelled under the 48 hour policy, the free touch up will be voided. *agreeAll appointments are made online through the web scheduling program. Cancelations and rescheduling is not accepted via text, email or social media platforms. Clients can visit the web site or follow the link in their appointment confirmation email to alter their appointments. All appointments are made and cancelled through the website booking system by the client. *agreeAppointments cannot be canceled or rescheduled over the phone, text or email 48 hours minimum prior to scheduled appointment. No one under the age of 18 is allowed in a tattoo of permanent cosmetic treatment room per Southern Nevada Health District. You must make arrangements for children. Client/recipient guests are not permitted in the treatment rooms. If a client brings a friend or family member, their guest is welcome to wait in the reception area. UPDATE: Due to COVID-19 restrictions, no guests are permitted. You must have an appointment to enter the facility with an approved health screening. *agreeSome clients desire to document their experience on their personal social media accounts. We do not allow audio, video or photography of staff or other guests. We understand there is a strong desire to share an exciting experience, but we must insist clients respect the privacy of staff and other guests. We do take before and after pictures of clients for their file and our insurance requires it. These photos are not optional. *agreeClient privacy is of the upmost importance. We do not share or sell any client contact information. Your information is secure. *agreeAll permanent makeup requires after care during the healing process. You agree to use your ointment for 7 days and follow the easy after care instructions that will be provided at your appointment. *agreeI have answered the questions in this document to the best of my ability and agree to terms of service.Digital Signature: Type Full Name and agree to terms of service.Submit NPMUA site and service terms of service.
