Name

First Name

Last Name

Date of Birth

YYYY

Phone

(###)

###

####

Occupation

Are you over the age of 18?

Have you made a booking with Woven Ink.?

Which Treatments do you wish to have?

Powder Brows

Lip Blush

Desired Result

Natural

Defined

Bold/Full Makeup look

Not sure

Have you had any previous cosmetic tattooing?

If so, please provide details

Area the tattoo is on How old is the tattoo Are happy with it

Do you have any moles or scars in the area to be tattooed?

Are you pregnant, breastfeeding or planning on pregnancy?

Have you had any cosmetic injectables in the area you wish to get tattooed in the last 6weeks?

Please tick your skin type

Very Dry

Dry

Normal

Combination

Oily

Very Oily

Please list all active skincare used

Vitamin A serum, Lactic Acid AHA, BHA. If you are unsure just let us know what brands you are using*

Are you currently taking or have taken any medication in the last 6months?

If yes please list

Including; Roaccutane / Insulin / Blood Thinners / Steroids / Antabuse / Aspirin / Anti-Coagulant / Antibiotics / Natural supplements / Fish oil

Do you have any known allergies?

Including; anaesthetics: Tetracaine, Lidocaine, Novocain or any other / Latex / Lanolin / Nickel / Food / Make up / Sunscreen / Hair dye

Do you suffer with any known medical condition?

If yes please provide more details

Including; Major Heart Issues / Bleeding disorder / Blood Clotting Disorders / Hemophilia / Organ Transplants / Diabetes type 1 / Hepatitis / Lung Disease / Asthma / Cancer / Undergoing Radiation Therapy or Chemotherapy / Infectious Diseases / Lupus / Shingles / HIV Positive / Venereal Disease / Fever / Iron Deficient / Anemia / Respiratory Problems / Skin Disorders / Hyperpigmentation / Keloid Scarring / Alopecia / Vitiligo / Scars / Cold Sores / Eczema / Psoriasis / Wounds Healing Problems / Mouth Ulcers / Recent Surgery / Blisters / Epilepsy / Anxiety / Fainting

I understand that failing to fill out this form truthfully and correctly may result in my appointment not being able to be completed.

In this instance I understand and accept that my $100 deposit will be void

Yes

I understand that a $100 deposit per appointment booked will be required to secure my appointment. Failure to give 72 hours notice of cancellation, or failing to read the requirements in the pre treatment care prior to this 72 hour period may result in my deposit being void.

Yes

I understand that I must attend my appointment alone and that no one is allowed in the treatment room apart from myself.

Please do not bring children or babies

Yes

I have read, understood and will adhere to the before care over on the FAQ page.

Yes

I have read, understood and will adhere to the aftercare over on the FAQ page.

Yes

I give consent for images, pictures and videos of myself pre, during and post treatment to be used for social media and advertising including on the website or shown to other clients to showcase my work.

Yes

Thank you!

Someone will be in contact shortly.

Online Consultation

Is cosmetic tattooing suitable for me?

Location

Contact