- Online Consultation -

Your Online Consultation

Fill out the form below for a free online consultation or go to our contacts page for other ways to get in touch.

Name*
Email*
State*
Mobile*
Are you over the age of 18?
- Yes
- No
Do you have skin cancers currently or removed in the past?*
- Yes
- No
Do you have rosacea?*
- Yes
- No
Are you currently on any medication?**
*If so, please list them and what they are for
Are you able to use topical anaesthetics?*
(lignocaine, tetracaine, prilocaine, epinephrine)
- Yes
- No
Are you pregnant, planning pregnancy or breastfeeding?*
- Yes
- No
Do you have oily skin?*
- Yes
- No
Have you had your eyebrows tattooed before?*
- Yes
- No
If so, where & how many times?*
- Yes
- No
Do you have health concerns?**
*If so, please list all and any health concerns you have now or have had in the past:
Are you iron deficient or anemic?*
- Yes
- No
Do you suffer from keloid scarring?*
- Yes
- No
Do you suffer from anxiety/depression?*
- Yes
- No
Do you have a thyroid condition?*
- Yes
- No
Do you have an auto immune disease?*
- Yes
- No
Have you been treated for cancer in the last 2 years?*
- Yes
- No
Have you used Roaccutaine in the past 12 months?**
*If yes, please note this will affect the pigment outcome-regardless of how long ago you took the medication. Must be at least 1 year post treatment.
- Yes
- No

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