Surveypoint

Q1

Date

Q2

Name

First Name

Q3

Name

Last Name

Q4

Email

Q5

Phone Number

Q6

Have you had permanent make-up before?

Yes

No

Q7

Are you pregnant or lactating?

Yes

No

Q8

Have you recently had facial surgery?

Yes

No

Q9

Have had an organ transplant?

Yes

No

Q10

Do you plan on going on a vacation in the next 3 weeks?

Yes

No

Q11

Which medications do you use?

Q12

Do you suffer any of the following diseases?

Q13

How much hair do you have in your brow?

Q14

Do you want lip liner only or a liner with shading?

Q15

Makeup Pre Procedure -Form Fill

Date

Name

Name

Email

Phone Number

Have you had permanent make-up before?

Are you pregnant or lactating?

Have you recently had facial surgery?

Have had an organ transplant?

Do you plan on going on a vacation in the next 3 weeks?

Which medications do you use?

Do you suffer any of the following diseases?

How much hair do you have in your brow?

Do you want lip liner only or a liner with shading?

How wide do you want your eyeliner?