About this template
Preparing for cosmetic tattooing procedures like microblading, lip blushing, or permanent eyeliner requires a thorough understanding of each client's health background and expectations. This Permanent Makeup Client Information Form helps beauty professionals collect essential contact details, medical history, skin sensitivities, and procedure consent before any session begins.
By gathering critical health details—such as current medications, known allergies, and pregnancy status—artists can screen for contraindications, ensure client safety, and deliver customized treatments. The built-in consent section ensures clients understand the procedure, healing process, and aftercare requirements.
With Doc2Form, you can instantly turn this template into a ready-to-use Google Form, making digital pre-screening seamless for your studio and your clients.
Key features
- Collect complete client contact details and date of birth in one secure place.
- Screen for critical medical conditions, medications, and skin allergies.
- Verify pregnancy and breastfeeding status prior to cosmetic procedures.
- Include built-in consent language regarding treatment risks and aftercare.
- Fully customizable via Google Forms to match your studio branding.
Use cases
- Microblading and brow tattooing pre-procedure health screenings.
- Lip blushing and permanent eyeliner client intake and consent.
- General aesthetic salon consultations and liability waivers.
- Tracking client referral sources to measure marketing effectiveness.
What this form collects
- Full Name (Short answer)Enter your first and last name as it appears on your government-issued ID.
- Email Address (Short answer)We will use this to send your appointment confirmation and aftercare instructions.
- Phone Number (Short answer)Enter the best number to reach you regarding your appointment.
- Date of Birth (Date)You must be at least 18 years old to receive permanent makeup services.
- Gender (Multiple choice)Select how you identify.
- Home Address (Paragraph)Street address, city, state, and ZIP code.
- How did you hear about us? (Dropdown)Let us know how you found our studio.
- Are you currently taking any prescription medications? (Multiple choice)Include blood thinners, acne medications like Accutane, or skin-thinning topicals.
- If yes, please list your current medications (Paragraph)List the names of any medications or supplements you take regularly.
- Do you have any known allergies? (Multiple choice)Include allergies to topical anesthetics (lidocaine), latex, metals, or specific pigments.
- Please detail any allergies listed above (Paragraph)Describe your reaction to the allergen.
- Are you pregnant or breastfeeding? (Multiple choice)Permanent makeup is not performed on individuals who are pregnant or nursing.
- Client Acknowledgment & Signature (Short answer)By typing your full legal name below, you confirm that the information provided is accurate and that you consent to the permanent makeup procedure.
- Date Signed (Date)Today's date.
FAQ
How do I share this form with my clients?
Once generated in Google Forms, you can easily share the link via email or text, embed it on your studio website, or have clients fill it out on a tablet in your waiting room.
Can I add or remove questions from this template?
Yes! Because the template lives in your Google Drive as a Google Form, you have full control to add custom questions, adjust options, or edit the consent text at any time.
Why is medical history important for permanent makeup?
Certain medications, skin conditions, and medical statuses can affect pigment retention, healing time, or increase bleeding risks during cosmetic tattooing. Pre-screening helps ensure client safety.
How does Doc2Form help me set up this form?
Doc2Form instantly converts this template into a fully structured Google Form in your account, saving you the time of building every question and section from scratch.
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.