PMU Intake Form | BeautyaestheticsbyMS

Permanent Makeup Pre-Appointment Intake & Aftercare Acknowledgment

Please complete this form before your permanent-makeup appointment. This pre-appointment intake helps Beauty Aesthetics by MS review health and safety information in advance. Final treatment consent, brow design approval, and practitioner documentation are completed separately.

Client Information

First name

Last name

Email

Phone number

Date of birth

Month

Day

Year

Do you have previous permanent makeup or tattoo pigment in the treatment area?

Yes

No

Medical History & Safety Questionnaire

Please answer honestly. A YES answer does not automatically prevent treatment, but it may require postponement, modification of the service, or medical clearance. Do not stop prescribed medication unless your prescribing clinician tells you to do so.

Are you pregnant or could you be pregnant?

Yes

No

Do you have a history of herpes infection at or near the proposed procedure site?

Yes

No

Do you have diabetes?

Yes

No

Have you had an allergic reaction to latex?

Yes

No

Have you had an allergic reaction to antibiotics?

Yes

No

Do you have hemophilia or another bleeding/clotting disorder?

Yes

No

Do you have cardiac valve disease or a heart condition for which you are advised to take antibiotics before dental or surgical procedures?

Yes

No

Are you currently taking any prescription medications, over-the-counter medications, or supplements?

Yes

No

Is there any health or exposure information related to bloodborne infections that you believe the artist should know for safe treatment?

Yes

No

Do you bruise or bleed easily, or are you taking blood thinners, aspirin, frequent NSAIDs, or other products that may increase bleeding?

Yes

No

Do you have a history of keloids, hypertrophic scarring, delayed wound healing, or poor pigment retention?

Yes

No

Do you have eczema, psoriasis, dermatitis, acne, rash, sunburn, open wounds, infection, or other active skin condition in or near the treatment area?

Yes

No

Do you have an autoimmune condition, immune suppression, current chemotherapy/radiation treatment, or another condition that may affect healing?

Yes

No

Have you recently used isotretinoin/Accutane or any prescription acne medication?

Yes

No

Do you currently use retinoids/Retin-A, glycolic acid, AHAs, exfoliating acids, lightening products, or other strong skin-renewal products near the treatment area?

Yes

No

Have you recently had Botox, filler, a brow lift/facelift, laser treatment, microneedling, a chemical peel, dermabrasion, or another intensive facial treatment?

Yes

No

Are you breastfeeding/nursing?

Yes

No

Have you consumed alcohol or recreational drugs today, or are you currently under the influence?

Yes

No

If you answered YES to any question above, please explain and list any current medications, supplements, and allergies

I certify that the information above is true and complete to the best of my knowledge. I agree to notify the artist of any change in my health, medications, skin condition, or pregnancy status before any future session.

Current Eyebrow Aftercare — Please Plan Ahead

Immediately after the procedure, use the provided moistened cotton pads to gently blot — not rub — the brow area every 30 minutes until bedtime. The next day, continue blotting every 3 to 4 hours as gently as possible. For the first two days only, keep both brows clean with water, using a cotton swab if needed. After the second day, do not touch the brows. After the first two days, do not allow the brows to be wet for the first 2 weeks; this includes excessive sweating and steamy showers. Avoid brow makeup, waxing, threading, and tinting for 3 weeks. Do not pick, pull, or scratch crust/scabbing; allow it to exfoliate naturally. Brows may appear about 30% darker than the final outcome. 6D microblading follows the same healing process and aftercare as ombre brows.

I have reviewed these current eyebrow aftercare instructions and understand that I should plan around the 2-week water/sweating restriction and the 3-week brow makeup/waxing/threading/tinting restriction.

I understand this online pre-appointment intake does not replace the final treatment consent, design approval, or any additional documents that Beauty Aesthetics by MS may require before the procedure begins.