Pre-Treatment Questions

Name

Mobile Number

Email Address

Please tick any of the following that apply to you Please tick any of the following that apply to you Under the age of 18 HIV/AIDS Hepatitis A, B, C Organ transplant Lupus Cancer/Chemotherapy – in the last 3-6 months Keloid Scarring Glaucoma/Laser Eye Surgery in the last 6 months (Only for Eyeliner treatments) Pregnant or Breast-feeding Facial Surgery or skin cancer removal in the last 3 months Roaccutane use in the last 12 months Cold Sores (even if you haven’t had one for years) NONE OF THE ABOVE APPLY TO ME

If any of the following apply to you, we will request a doctors approval for your treatment If any of the following apply to you, we will request a doctors approval for your treatment Diabetes Heart conditions/ Pacemaker Haemophilia Epilepsy Auto immune/Liver diseases Cancer/ Chemotherapy NONE OF THE ABOVE APPLY TO ME

If any of the following is relevant for you on the day of your treatment, we will need to reschedule your appointment If any of the following is relevant for you on the day of your treatment, we will need to reschedule your appointment Cold and Flu Symptoms General anaesthetic in the last 2 weeks Anti- wrinkle injections in the Tattoo area in the last 14 days Dermal filler in the Tattoo area in the last 4 weeks Currently active Cold Sores - Including Brow and Eyeliner treatments Currently active Rosacea, Psoriasis, Eczema Antibiotic use in the last 2 weeks

I HAVE READ AND UNDERSTAND THE ABOVE I HAVE READ AND UNDERSTAND THE ABOVE Tick this box to confirm.

Please avoid the following prior to your procedure; Please avoid the following prior to your procedure; Dermal filler in the Tattoo area - 4 weeks prior Anti- wrinkle injections in the Tattoo area - 2 weeks prior For Brow tattoo; Eyebrow wax or tint - 7 days prior For Eyeliner tattoo; Eyelash lift or tint – 7 days prior For Eyeliner tattoo; Lash Extensions removed 1-2 weeks prior For Eyeliner tattoo; Stop using serums 4 weeks prior (12 weeks if possible) IPL, Laser, Chemical peel, Skin needling, Microdermabrasion- 14 days prior Stop any type of blood thinners/Anti-Inflammatories 3 days prior (fish oil, vit E, asprin, nurofen, advil, etc) Avoid the sun, as area must not be sunburnt on the day of treatment Avoid drugs or alcohol 2 days prior Avoid Coffee 6 hours prior to Treatment Consider washing your hair prior to treatment, as the tattoo must be kept out of water for 10 days. Please book for a patch test if you suffer from any known allergies or skin irritations from the use of serums, creams, skin treatments etc. This applies to all cosmetic tattoo procedures, henna brow, lash lift and tint & ISR revision.

* Some of these may not apply to you, depending on which service you choose* * Some of these may not apply to you, depending on which service you choose*

I HAVE READ AND UNDERSTAND THE ABOVE I HAVE READ AND UNDERSTAND THE ABOVE Tick this box to confirm.