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FAQ

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CLIENT FORM

Are you pregnant and/or breastfeeding?

Yes No

Details:

Have you ever had any coldsores?

Yes No

Details:

Do you have any allergies?

Yes No

Details:

Have you ever had any permanent cosmetics or tattoos applied? Please describe where on your face/body and approximate date.

Yes No

Details:

Do you wear contact lenses? If you are having the cosmetic eyeliner procedure please bring glasses to wear as contacts can only be worn once you have completely healed.

Yes No

Details:

Do you use any lash growth serums? If you are having a cosmetic eyeliner procedure, you will need to stop this for 4 weeks prior to your appointment.

Yes No

Details:

Do you have any health issues or conditions?

Yes No

Details:

Are you a diabetic? If so, type 1 or type 2?

Yes No

Details:

Do you have any auto-immune disorders?

Yes No

Details:

Do you tend to develop keloid or hypertrophy scars?

Yes No

Details:

Do you consume asprin, Omega Fish oils, Ibuprofen or tumeric daily?

Yes No

Details:

Do you take any medication?

Yes No

Details:

Do you have botox injections? If so, when was the last procedure and where on the face?

Yes No

Details:

Are you now or have you ever been on the acne treatment Accutane (Roaccutane). You will need to wait for one year before getting a tattoo.

Yes No

Details:

Do you have any skin disorders or diseases?

Yes No

Details:

Are you allergic to hair dyes?

Yes No

Details:

Do you have glaucoma or any other eye disease or condition?

Yes No

Details:

Do you have any type of hepatitis or HIV?

Yes No

Details:

Do you exercise? Please note: NO exercise for five days after treatment

Yes No

Details:

Date of Birth

Today's Date

NOTE: Writing your name below constitues as an electronic signature.

Please upload a photo of your government issued photo ID

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022 069 3390
katellenstudio@gmail.com
Morrinsville, Waikato

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