Microblading Questionnaire – Drench Day Spa & Lash Lounge

Name*

First Last

Email*

Phone*

Are you in the Jackson area?*

Yes
No

Are you currently pregnant or breastfeeding?*

Yes
No

Have you ever been prescribed acutane? If so, when was the last time you took it?*

Do you have any previous permanent makeup in the brow area?*

Yes
No

Do you have any scars in or around the brow area?*

Yes
No

Do you have a predisposition for form keloid scars?*

Yes
No

Botox?*

Yes
No

Botox - How long ago was it?*

Do you have alopecia or trichotillomania (compulsive pulling of body hair)?*

Yes
No

Do you have eczema or dermatitis in or around the brow area?*

Yes
No

Are you Diabetic?*

Yes
No

How would you rate you skin?*

Normal
Combination
Oily
Severely Oily

Do you have large pores?*

Yes
No

Do you have moles/raised areas in or around the brow area?*

Yes
No

Do you have or have had a piercing in the brow area?*

Yes
No

Have you had a hair transplant for your eyebrows?*

Yes
No

Do you tan or exercise frequently?*

Yes
No

Please list any prescribed medication you are currently taking.

Now please email a photo of your brow area. Make sure your makeup-free and the photo is taken in a well-lit area. We will inform you if you need to send another photo.

Please email your photo to: drenchclients@gmail.com

Please press the submit button to submit the form.