(PMU + Lash Extensions — Client-Friendly & Compliance Ready)

CONTACT & MEDICAL

• Full Name:

• Email:

• Phone:

• How did you find us? (Referral / Google / IG / TikTok / Walk-in)

• Are you currently pregnant or breastfeeding?

• Any allergies? (Lidocaine, latex, pigments, adhesives, etc.)

• Any skin conditions? (eczema/psoriasis/keloids/acne)

• Any recent cosmetic procedures? (Botox, fillers, peels, microneedling, etc.)

• Do you have a history of cold sores? (Lips PMU clients only)

SERVICE GOAL

• Which service are you interested in?
  ☐ Wispy Lash Extensions
  ☐ Permanent Brows (Suji Technique)
  ☐ PMU Correction / Removal
  ☐ Lash Lift & Tint
  ☐ Lip Neutralization

• What is your biggest concern about your current lashes/brows/lips?

• What result do you want?
  ☐ Natural enhancement
  ☐ Noticeable definition
  ☐ Dramatic transformation

PHOTO UPLOAD

• Please upload 2 clear photos in daylight:
  ✅ Full face looking forward
  ✅ Brows/Lashes close-up

COMMITMENT

• Are you willing to follow the healing instructions and avoid:
  ✅ Saunas/steam
  ✅ Sweating
  ✅ Makeup on treated area
  ✅ Picking/scabbing