About this template
The Permanent Makeup Consultation Google Form Template is an essential tool for beauty professionals, cosmetic tattoo artists, and salon owners preparing clients for semi-permanent procedures like microblading, lip blushing, or eyeliner tattooing. Before any cosmetic procedure, gathering accurate health history and assessing potential contraindications is critical for both safety and optimal results.
This comprehensive form collects essential client personal details, detailed medical histories, current medication usage, known allergies, and specific conditions such as pregnancy, skin treatments, or past micropigmentation work. It also includes required acknowledgment statements and consent confirmations to ensure clients are fully informed before their appointment.
Using Doc2Form, you can instantly turn this template into a live Google Form, customize it with your studio branding, and send it directly to clients before they arrive. Streamlining your pre-procedure screening reduces administrative overhead, protects your business with clear acknowledgments, and gives you the exact health data needed to deliver flawless, safe results.
Key features
- Collect detailed medical history and allergy information safely
- Screen for contraindications like pregnancy, medications, and skin treatments
- Include built-in legal acknowledgments and consent statements
- Save appointment time by gathering client paperwork in advance
- Fully customizable for any brow, lip, or cosmetic tattoo studio
Use cases
- Pre-appointment screening for microblading and permanent makeup artists
- Initial client health intake for medical spa cosmetic procedures
- Liability and consent documentation for lash and brow salons
- Remote client assessment prior to studio visits
What this form collects
- Full Name (Short answer)Enter your first and last name as it appears on official documents.
- Date of Birth (Date)Enter your date of birth.
- Phone Number (Short answer)Enter the best phone number to reach you regarding appointment updates.
- Email Address (Short answer)We will send your appointment confirmation and pre-care instructions here.
- Home Address (Paragraph)Street address, city, state, and zip code.
- Desired Procedure or Service (Dropdown)Select the permanent makeup service you are booking for.
- Preferred Appointment Date & Time (Short answer)Provide your preferred date and time for the consultation or procedure.
- Are you currently taking any prescription medications? (Multiple choice)List any blood thinners, acne medications (like Accutane), or other regular prescriptions.
- Please list your current medications and their purpose (Paragraph)If you answered yes above, please provide details.
- Do you have any known allergies? (Multiple choice)Include allergies to latex, pigments, numbing agents, metals, or topical anesthetics.
- Please list your allergies (Paragraph)If you answered yes above, please specify what you are allergic to and your reaction.
- Are you currently pregnant or breastfeeding? (Multiple choice)Permanent makeup is not performed during pregnancy or while breastfeeding for safety reasons.
- Have you had Botox or facial injectables in the past 4 weeks? (Multiple choice)Select your current status regarding recent facial treatments.
- Medical Conditions Check (Paragraph)Please indicate if you have or have had any of the following conditions: Diabetes, Keloid scarring history, Epilepsy, Hepatitis, HIV/AIDS, Chemotherapy (within past year), Hemophilia/Bleeding disorders, or Skin conditions in the treatment area (eczema, psoriasis).
- Have you had previous micropigmentation or cosmetic tattoos in this area? (Multiple choice)Let us know if you have existing pigment from a previous artist.
- How did you hear about us? (Dropdown)Select your referral source.
- Acknowledgment and Consent (Short answer)By typing your full name below, you confirm that all information provided is accurate and true to the best of your knowledge, and that you consent to the consultation.
- Signing Date (Date)Enter today's date.
FAQ
How does Doc2Form help me use this template?
Doc2Form instantly converts this template into a ready-to-use Google Form, allowing you to start collecting client consultations and medical history within seconds.
Can I customize the medical questions for different procedures?
Yes! Once the template is in your Google Forms account, you can freely add, remove, or edit any questions to fit microblading, lip tattooing, or scalp micropigmentation.
Why is a health consultation necessary before permanent makeup?
Certain medications, skin conditions, and medical histories can affect pigment retention, healing, and overall procedure safety. This form ensures you catch any potential risks beforehand.
How do clients sign or acknowledge the form?
The form includes dedicated fields for acknowledgment statements and text-based signatures so clients can confirm they understand the pre-care and post-care requirements.
Is this template mobile-friendly for my clients?
Yes, Google Forms are fully responsive and optimized for mobile devices, allowing clients to fill out their consultation paperwork conveniently from their phones before arriving.
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.