Consultation Questionnaire
The Artist assumes no liability in case of false or incomplete information provided by the client. This information is confidential and it will be treated that way. 
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Date : *
Full Name : *
Phone no. *
Age *
Sex  *
Occupation *
Address *
How did you get to know about us? *
Q. Do you suffer from the following diseases or are you taking any of these medications? *
Required
Q. Are you taking any blood thinner? (If yes, specify) *
Q. Are you pregnant or nursing? *
Are you planning to conceive ? *
Are you or were you taking contraceptives? *
Q. Do you use a pacemaker? *
Q. Have you undergone any surgery in the last 5 years? If Yes (Please Specify) *
Q. Do you have a problem with healing wounds? *
Q. Are you getting any medical treatments on the FACE ?  *
Required
If your answer was yes to the above question. Please share the last date of your session along with no. of sessions taken & due for the same.
 *
Q. Are you taking any medicines or supplements on a daily basis? If yes, please share the name or pictures of the same. *
Q. Have you ever got any Permanent Makeup treatment done before?  *
If your answer was yes to the above question please specify when was the session done ? and the number of sessions for the same.
Q. Do you have a keloid scar? *
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Q. What is your skin type? *
Required
Q. Are you using any of the following? *
Required
Q. How often do you exercise in a week? *
Please list down your skincare products that you use on a daily/weekly basis. (Please specify the brand and product name) *
What is your main concern ? *
Required
What would you like to achieve from your treatment? *
Required
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