- 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 forAre 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 Δ
