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Brow Client Consultation Form
PLee Beauty, LLC | 3409 Schofield Ave. Suite A Weston, WI 54476 | 715-254-8989
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First & Last Name
*
Your answer
Date of Birth
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MM/DD/YY
MM
/
DD
/
YYYY
Phone#
*
Your answer
Email
*
Your answer
Will this be for a brand new set of brows, or a cover up?
*
Brand New
Cover Up
Do you presently have or previously had any of the following? (check all that applies)
*
Botox
Diabetes
HIV
Lip fillers/ Restylane/ Juvederm
Cold Sores/ Fever Blisters
Blepharoplasty (Eyelid surgery)
Hepatitis (A,B,C,D)
Brow lift
Easy bleeding
Face lift
Alcoholism
Eye surgery/ injury/ Corneal abrasion
Abnormal Heart Condition
Chemical Peel
Contact Lenses
Pregnant now/ Breast feeding now
Brow or Lash tinting
Oily Skin
Accutane or acne treatment
Keloid
Vegan
Cancer
Waxing
Tan by booth or sun
Difficulty numbing with dental work
Taking blood thinners such as: Aspirin, Ibuprofen, alcohol, etc.
Allergic reaction to any medications such as Lidocaine , alcohol, etc.
Allergies to metals, food, etc.
Do you use skin care products containing Retin-A, glycolic acid or alpha hydroxyl?
None
Required
Any diseases or disorders not listed above?
*
Your answer
List medications or vitamins you’re presently taking.
*
Your answer
A non-refundable $100 deposit is required to secure an appointment. Once a date is set and the deposit is made, you will receive an appointment notification. Submission of this form does not guarantee you an appointment. PLee Beauty will reach out to you to discuss further details.
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