About this template
Preparing clients for semi-permanent brow procedures requires careful screening for health conditions, medications, and allergies to ensure safe results. This Microblading and Ombre Treatment Google Form Template helps permanent makeup artists, brow technicians, and salon owners collect essential client health histories, photo references, and signed legal consents in advance of appointments.
By gathering crucial details days or weeks before the session, practitioners can identify contraindications early, review previous medical history, and avoid day-of cancellations. Clients can easily complete their contact information, upload required facial photographs, disclose recent medication intake, and formally acknowledge treatment risks and topical anesthetic consents from any device. Utilizing Doc2Form to turn this template into a live Google Form cuts down on clipboard clutter and ensures your studio maintains organized, digital client records.
Key features
- Collect comprehensive client contact and background information
- Screen for medical conditions, allergies, and recent medication use
- Gather high-resolution photo references for precise brow mapping
- Obtain digital acknowledgment of risks and topical anesthetic consent
- Reduce day-of appointment cancellations through proactive health checks
Use cases
Pre-appointment screening for new microblading and ombre brow clients
Collecting digital informed consent and risk liability waivers
Gathering pre-procedure facial photos and aesthetic preferences
Documenting medical history and anesthetic agreements for cosmetic ta…
Documenting medical history and anesthetic agreements for cosmetic tattooing
What this form collects
- Full Name (Short answer)Enter your first and last name as it appears on your ID.
- Email Address (Short answer)We will send your appointment confirmation and aftercare instructions here.
- Mobile Phone Number (Short answer)Enter the best number to reach you via call or text regarding your appointment.
- Date of Birth (Date)You must be at least 18 years old to receive this procedure.
- Residential Address (Paragraph)Enter your street address, city, state, and postal code.
- Occupation (Short answer)Optional: helps us understand your daily exposure to sun, sweat, or harsh environments.
- Close up front view of both brows (Paragraph)Please paste a link to a clear, makeup-free photo of both brows (Google Drive, Dropbox, etc.).
- Close up of right brow (Paragraph)Please paste a link to a clear photo of your right brow.
- Close up of left brow (Paragraph)Please paste a link to a clear photo of your left brow.
- Full facial photo (Paragraph)Please paste a link to a full, makeup-free facial photo looking straight ahead.
- Microblading Treatment Required (Multiple choice)Select the specific service you are booking.
- Medications (last 6 months) (Paragraph)List any prescription or over-the-counter medications, blood thinners, or acne treatments (such as Accutane) taken in the last 6 months.
- Recent intake status (last 48 hours) (Multiple choice)Have you consumed alcohol, aspirin, ibuprofen, or caffeine in the last 48 hours?
- Allergic Reaction Status (Multiple choice)Do you have any known allergies to pigments, metals, latex, or topical anesthetics (lidocaine, tetracaine)?
- Allergy Details (Paragraph)If you answered yes above, please list your specific allergies.
- Medical Conditions Status (Multiple choice)Do you have any of the following: pregnancy, breastfeeding, history of keloid scarring, diabetes, hemophilia, or active skin infections?
- Chemotherapy or Radiation Status (Multiple choice)Have you undergone chemotherapy or radiation treatments within the past year?
- Doctor Contact Information (Paragraph)If you are under the care of a physician for any condition affecting this procedure, please provide their name, clinic name, and phone number.
- Risk Statement Acknowledgement (Multiple choice)I understand that semi-permanent cosmetic tattooing involves inherent risks such as minor swelling, redness, irritation, and potential allergic reactions.
- Procedure Consent Acceptance (Multiple choice)I voluntarily consent to undergo the microblading or ombre brow procedure performed by my technician and confirm that all information provided is accurate.
- Topical Anaesthetic Consent (Multiple choice)I give permission for the application of topical anesthetics (numbing cream/gel) during the procedure to minimize discomfort.
FAQ
Why is a pre-treatment consent form necessary for microblading?
A pre-treatment consent form ensures clients are fully informed about potential risks, healing processes, and aftercare requirements while screening for medical conditions or medications that could impact pigment retention or healing.
How can I customize this template for my brow studio?
Once you bring this template into Google Forms via Doc2Form, you can easily add your studio name, adjust medical history questions, or include specific local liability clauses tailored to your practice.
How far in advance should clients fill out this form?
We recommend having clients complete this form several days or weeks prior to their scheduled appointment to allow adequate time to review medical disclosures and reschedule if contraindications arise.
Can clients upload reference photos through this form?
Yes, clients can paste links to reference photos (such as Google Drive or Dropbox links) or describe the required facial views to help you prepare for their brow mapping session.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.