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MAKE AN APPOINTMENT
About
FAQ's
About Savannah
TRAINING
Contact
Home
New Client Submissions
Portfolio
Pricing
Booking
Before You Book
New Client Form
MAKE AN APPOINTMENT
About
FAQ's
About Savannah
TRAINING
Contact
Booking
Before You Book
New Client Form
MAKE AN APPOINTMENT
Please complete this form before booking your appointment
Name
*
First Name
Last Name
DOB
*
MM
DD
YYYY
Age
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email Address
*
Contact Number
*
(###)
###
####
Occupation
List any medications you have been taking in the past 6 months
Have you received chemotherapy in the past year?
*
No
Yes
Have you had an allergic reaction to one of the following?
Latex Rubber
Antibiotics
Medication
Lidocaine
Other allergies:
Are you required to take antibiotics prior to dental or surgical procedures?
*
No
Yes
Have you ever had one of the following?
Retin A within the last 2 weeks
Prolonged bleeding
Diabetes
Artificial heart valves
Cardiac valve disease
Hemophilia or other bleeding disorder
Fainting spells or dizziness
Liver disease
HIV
Hepatitis
Cancer
Chemical or laser peel within 6 weeks
Alopecia
Fat injections, botox injections, collagen injections
Keloid scars
Healing problems
Herpes infection at the proposed procedure site
Do you scar easily?
*
No
Yes
Do you bruise easily?
*
No
Yes
Are you currently pregnant or nursing?
*
No
Yes
What are your main concerns relating to your eyebrows?
What would you like to improve?
Think about shape, color, density, thickness:
Thank you!