Online Consultation Form

Permanent Cosmetic Client Intake Form

Name
First Last
Email
Phone
Are you over 18 years old
- Yes
- No
I am interested in the following procedure:
- Eyebrows
- Eyelids
- Lips
- Micro Needling
- Other (Facials, Waxing)
Please list any medical, health and/or skin conditions/sensitivities
Please list any medications, including topical, prescriptions and vitamins you are taking
Please describe your desired outcome
Upload a image of yourself

Permanent makeup is NOT recommended for any clients who are or have:

Must not be pregnant or nursing.
Please note that you will be more sensitive during your menstrual cycle.
Skin irritations or Psoriasis near the treated area (rashes, sunburn, acne, etc.)
Sick (cold, flu, etc.)
Botox in the past 1 month
Accutane in the past year
Pacemaker or major heart problems
Organ transplant

We are conveniently located in the Seabright area between the cross streets of Federick and South Morrissey.
349 Gault Street, Santa Cruz.

Our hours are 9am – 6pm, by apppointment only, Tuesday through Saturday. You can always book online.

Call today – 831.426.4321 to make your appointment!

Connect Today!