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Microblading & Permanent Make Up Client History Form
Please fill out prior to your Microblading or Permanent Make Up appointment
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Email
*
Your email
Today’s Date
*
MM
/
DD
/
YYYY
Full Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Age
*
Your answer
Address
*
Your answer
Phone Number
*
Your answer
How did you find us?
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone
*
Your answer
Tattoo Artist
Kathy Cula
Lourdes Mejia
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