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Cosmetic Tattoos
Intake Form

First name*

Last name*

Email*

Phone*

Pronouns*

Desired Service*

*This service is only available for those who completed their first session with Hygge Ink at Slowpoke Tattoo.

Skin Type*

Select All That Apply

Allergic reactions to any medications like lidocaine or tetracaine, etc. If yes, specify below.

Allergies to food/metal/latex

Hepatitis (A, B, C, D)

Cancer (Please specify below)

Tuberculosis

Accutane treatment (please specify)

Keloids

HIV/AIDS

Hemophilia/Easy bleeding

History of staph infection

Alopecia

Diabetes

Eczema/Psoriasis/ Dermatitis/ Rosacea or other skin conditions

Taking blood thinners (alcohol, aspirin, ibuprofen)

Autoimmune Disease such as Lupus (please specify below)

None of the above apply to me.

Please specify additional details from checked boxes above.

Have you had a chemical or laser peel? *

Yes

If yes, when

Have you ever had any permanent makeup procedure(s) before? *

Yes

If yes, when and what procedure(s)?

Are you pregnant, trying or nursing?*

Yes

Are you planning on having facial plastic surgery within the next 6 months?*

Yes

Have you ever had a facelift, forehead or brow lift?*

Yes

If yes, when?

Have you had laser or saline eyebrow removal before?*

Yes

If yes, when and how many sessions?

Have you ever gotten your eyebrows laminated or tinted? *

Yes

If yes, confirm which one and your last treatment.

Have you ever had an eyebrow transplant?*

Yes

If yes, when?

Have you received botox/fillers? *

Yes

If yes, when?

Do you have any scar(s) in the area to be treated?*

Yes

Are you a smoker?*

Yes

Do you have any problems with healing wounds?*

Yes

Have you had any complications with previous tattoos or permanent make up? *

Yes

If yes, please describe.

Are you taking any prescription medications?*

Yes

If yes, which ones?

Please attach the following photos of your face with no make up on: Straight-on, no smiling Straight-on, smiling Any inspiration pictures of eyebrows and/or freckles you like*

slowpoke tattoo

www.slowpoketattoo.com

The first tattoo shop featured at Lollapalooza and Austin City Limits Artist's Lounge.

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Cosmetic Tattoos Intake Form

Cosmetic Tattoos
Intake Form