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Brow Form

Name *

First

Last

Phone

Email *

Age *

DOB *

Upload a picture of your license (Required by Florida Health Department) *

Click or drag a file to this area to upload.

(Required by Florida Health Department)

Are you currently using any medications? *

Are you able to use topical anesthetics? (lignocaine, tetracaine, prilocaine, epinephrine) *

Are you pregnant, planning pregnancy or breastfeeding? *

Have you had your eyebrows tattooed before? *

Do you have any health concerns? *

Are you iron deficient or anemic? *

Are you prone to keloid scarring? *

Attach a clear image of your FULL FACE with no make-up on. (These must be taken with sufficient lighting.) *

Click or drag a file to this area to upload.

Attach a clear image of your LEFT EYEBROW with no make-up on. (These must be taken with sufficient lighting.) *

Click or drag a file to this area to upload.

Attach a clear image of your RIGHT EYEBROW with no make-up on. (These must be taken with sufficient lighting.) *

Click or drag a file to this area to upload.

I have read and understood the information provided to me above in the 'information pack' and have answered each question truthfully *

Yes, I have read and understood the INFORMATION PACK

Do you understand that tattooing is artistic in nature and no results or expectations can be guaranteed *

Yes, I UNDERSTAND

Do you understand that a tattoo is a permanent change to your appearance and can only be removed by laser or surgical means, which can be disfiguring and/or costly and which in all likelihood will not result in the restoration of your skin to its exact appearance before being tattooed? *