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Do you have any previous cosmetic tattoo? If so, please provide details; Area the tattoo is on, how old it is, if you are happy with it etc*

Which treatments are you wanting to have completed at Lash Noir Ink?*

Please confirm if you are pregnant or breastfeeding*

PregnantBreastfeedingNeither apply

Please list all medication you have taken in the past 12 months, including over the counter medications, prescription medications, pain killers and natural supplements*

Please list all medical conditions, mental and physical injuries recently or in the past eg. Diabetes, High Blood Pressure etc*

Please list all known allergies, eg. Latex, Nickel*

Please list all cosmetic enhancements you have undergone in the past 12 months. eg. Botox, Fillers, Peels, Cosmetic Surgery*

Please list all active skincare used. eg. Vitamin A serum, Lactic Acid. If you are unsure just let us know what brands you are using*

Please tick your skin type*

Please tick all that apply to your skin*

Please tick all that apply to your lifestyle*

Desired result*

Please tick all that apply to you*

I understand that failing to fill out this form truthfully and correctly may result in my appointment not being able to be completed at the allocated time. In this instance I understand and accept that my $100 deposit will be null and void.*

I understand that cosmetic enhancements are not always suited to every individual, and in the instance that the therapist does not believe she can achieve the desired result to a high standard I may be asked to sign additional waivers, or in some cases be refused treatment.*

I understand that a $50 deposit per appointment booked will be required to secure my appointment. Failure to give 48 hours notice of cancellation, or failing to read the requirements in the pre treatment email prior to this 48 hour period may result in my deposit being void*

I agree and understand that once my deposit is paid, this is non refundable but can be used as credit towards future treatments and/or retail products at both Lash Noir and Lash Noir Ink.*

I understand that Lash Noir Ink in the interests of other clients experiences, strictly cannot accomodate large groups of friends or family including children during wait times or treatment times.*

I understand that - I legally need to be over the age of 18 years or at least 16 years old and have written parents consent prepared prior to your treatment. I will notify Lash Noir Ink of this when confirming my bookings.*

I understand I will be required to pre numb my chosen area prior to the appointment. I also understand being ontime is essential to my final outcome. As a courtesy to the client that follows we cannot run late for any services.*

IMAGE UPLOAD - In order for us to allocate the correct staff member please upload a clear close up of your natural brows without makeup. Click here to upload.

Preferred Therapist*

Preferred day of the week*

Preferred time of day*