Printable Permanent Makeup Consent & Intake Forms Template

PERMANENT MAKEUP INTAKE AND CONSENT FORM (CUSTOMIZABLE)
A Permanent Makeup intake form is a document that is used by professional Permanent Makeup artists or estheticians to gather information about the client's medical history, lifestyle, and desired results before the procedure.

As a permanent makeup professional, you need a well-designed form to keep track of your client's personal details, medical history, payments, instructions, and consent approvals to avoid issues and protect   you and your business from possible litigation. This form is just what you need for this. It also includes an index section to quickly locate every client's details. Check below to view the content of this form.

CONTENT OF PERMANENT MAKEUP CONSULTATION FORM

1. Client information section

• Name
• Address, city, state and ZIP
• Date of birth
• Email and phone number
• Two emergency contact names and phone numbers
• Email list added request
• Specials & discount.
• Referrer

2. Medical and cosmetic history

• Up to 5 medical and cosmetic history questions.
• Up to 18 medical conditions for patient to client to tick whichever that apply.

3. Goal & Instructions section

• What exactly would you like to get out of this procedure.
• 3 Blank lines for other special instructions

4. Consent and signature

• Client consent section to protect you and your business.
• Client name, signature, and date.

5. Official section

• Who reviewed the form?
• Date and signature
• Comments
• Was client accepted or not?
• Reason for rejection.
• Procedure cost and discount (If any).
• Manager name, date and signature

6. Business Information

• Name
• Email and Phone
• Address

AVAILABLE FORMATS

• PowerPoint (Editable)
• PDF
• LARGE 8.5 x 11 INCHES