Name *

First Name

Last Name

Which of the following procedures are you interested in?

Brows - Ombre

Brows - Nano Strokes

Brows - Combo

Eyeliner - Thin Upper

Eyeliner - Thin Lower

Eyeliner - Medium Upper

Eyeliner - Creative Upper

Lips - Full Lip Tint

Other/ I need help choosing

Do you wear makeup daily? *

Yes - full face

Yes - minimal (ie. foundation and mascara)

Sometimes

No - but I would like to

No - I like natural

Please tick all that apply to your lifestyle *

Spend a lot of time outdoors

Exercise regulalry

Swim regularly

Sauna regularly

Smoker

None of the above

Preferred contact method

Email

Text message

Phone call

I understand that not all cosmetic tattoo enhancements are suited to every individual, if I request a treatment that is unsuitable the artist will offer; a better suited treatment option, I could be asked to sign additional waivers or treatment could be refused *

Yes

I understand that all treatments require two (rarely three) sessions to obtain the final result, this must be completed within 3 months of the previous session *

Yes

I understand that a $100 booking fee per appointment (new or colour refresh) will be required to secure my appointment. Booking fees are non refundable but they are transferable with 48 hours notice of cancelation *

Yes

I give permission for Poise Permanent Makeup to take before and after photos to keep on record *

Yes

I give permission for Poise Permanent Makeup to use my before and after photos for social media/website use *

This is greatly appreciated to showcase our work to other potential clients

Yes, close up procedure photos only

Yes, full face photos are allowed

No

I understand that Poise Permanent Makeup requests that I do not bring family or friends (unless prearranged) to my cosmetic tattooing appointment in order to focus solely on the client *

Yes

I have read and I accept the Terms of Service *

https://www.poisepermanentmakeup.nz/terms-of-service

Yes

I confirm all of the information I have given is true and correct *

Yes

Date *

MM

DD

YYYY