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Toronto Brow and Lashes Beauty, Brow and Lashes Specialists

Home
About Us
Services
Microblading
Consultation Form
After Care
Care
Make-Up
Contact
Book

CONSULTATION FORM

Consultation Form

Toronto Brow and Lashes is proud to announce it's collaboration with Misencil Eyelash Extensions.

Consultation Form

Name *

First

Last

Address

Phone

Email *

Referred by

Do you have any allergies? (i.e. Latex)

Yes
No

If yes, please specify

Are you allergic to anesthetics?

Yes
No

If yes, please specify

Are you allergic to antibiotics?

Yes
No

If yes, please specify (copy)

Have you had any eye surgeries?

Yes
No

If yes, please specify with date

Please specify any other allergies or concerns

Do you have any body tattoos?

Yes
No

Are you diabetic?

Yes
No

Do you bruise easily?

Yes
No

Have you ever had a fever blister, cold sore or canker sore?

Yes
No

Have you ever had a keloid scar on your body or are you prone to keloid scarring?

Yes
No

Do you have any serious medical conditions?

Yes
No

Are you currently pregnant or breastfeeding?

Yes
No

Do you have any heart conditions?

Yes
No

Does your skin easily swell?

Yes
No

Have you ever tested positive for HIV or Hepatitis?

Yes
No

Please specify any other medical conditions?

Are you currently taking any medications, including immunosuppressant such as an anti-inflammatory or steroid?

Yes
No

If yes, please specify

In case of an allergic reaction, are you able to take over-the-counter antihistamine (i.e.Benadryl)?

Yes
No

Do you use Retinol A, Hydroyl (Glycolic) Acid preparations, Proactiv or any other anti-aging/acne products?

Yes
No

If yes, specify

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