PMU training, certification, apprenticeship

Name *

First

Last

Age

Phone

Email *

When is your appointment? *

Have you been in before? *

Yes
No

Did you do a free virtual consultation? *

no
yes

Approximately when were in you in last to see Theresa? *

Services *

Details 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? *

no
yes

How many times have you had permanent makeup, microblading applied including touch ups?

Are you taking anticoagulants or blood thinners? *

no
yes

Are you allergic to anesthetic? Anesthetics are numbing agents. *

no
yes

We use lidocaine and benzocaine. Proper numbing is essential for client comfort and excellent results.

Check all that apply:

I have gotten a cold sore on my lips one or more times in my life. *

no
yes

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 understand

Before 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. *

agree

There 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. *

agree

All appointments are made online through the web scheduling program. Cancelations and rescheduling are not accepted via text, email, voicemail 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. *

agree

Appointments 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. *

agree

Some 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. *

agree

Client privacy is of the upmost importance. We do not share or sell any client contact information. Your information is secure. *

agree

All 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. *

agree

How will you be paying for your services? *

Cash discount 5%
Credit Card (MC & Visa only)
Afterpay Payment Plan (For multi-procedure packages only)

You selected a payment plan with Afterpay. We will send you a link to set up your payment plan prior to your appointment. If for any reason you are not approved for a payment plan by Afterpay or decide not to enter into a payment plan, payment is due in full the day of your appointment via cash or credit card. *

I understand

Afterpay payment plans are set up prior to scheduled appointments.

I 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.