805 550 7379

Step 2: Read, agree & return our pre-client questionnaire

  • Fill in the questionnaire below
  • Tick each of the boxes to confirm your agreement
  • Click the “Send Your Questionnaire” button

Clicking the button sends your questionnaire to Carolyn. You will then be directed to the next page (step 3) where you can send additional photos.

Pre-Client Questionnaire

Pre-Client Questionnaire
(No Exceptions) - Rapid swelling and bleeding is a complication from these products. Pigment does not retain.
Hair strokes will appear more blurred or blended if so.
No exceptions...PMU will not be performed as the procedure could cause a flare up.
Constant flaking/itching/irritation/shedding of skin
The hair strokes will appear more blended, solid or not retain at all.
Pigment will blur/blend in large pores looking powdered.
If you have hot flashes during the procedure, the pigment will not retain and the procedure may have to stop. (You will be required to sign and addendum prior to procedure)
An aggregation disorder is when platelets do not bind with fibrinogen and other proteins in order to stick to other platelets. As a result the platelets cannot form a plug to stop the bleeding from a damaged blood vessel.
Pigment will not be put into anything raised. No exceptions, even if it looks incomplete.
The Hair Strokes will not lay properly in the creases, giving the brow an uneven look
Pigment will not take in the scar tissue where the plugs were placed.
Due to the medicines to treat these diseases, pigment will not retain.
Due to the frequent production of sweat(salt), the pigment WILL NOT retain, WILL fade very quickly, appear blurred or change in color. THIS WILL HAPPEN!
Tanning, the results will fade quickly, heal darker, fade super fast or not retain at all. If you ruin the results by going out in the sun too soon, Mary may not be able to work on you in the future. Addendum will be required
And you can always send a photo later if you don't have one at the moment - simply go to the next step (Step 3) where you can upload photos directly from the website. Or you can use the email address to send an email with an attachment.
After you have answered all of the questions above, please click the Submit button to send your completed questionnaire.
We will evaluate your questionnaire, along with your photo before scheduling an appointment. Thank you.
Here is an example of a perfect image to help you
Drop a file here or click to upload Choose File
Maximum upload size: 15MB
You can send up to 4 photos - just click inside the box to add photos.

Please click the "Send Your Questionnaire" button below.

This sends your questionnaire to Carolyn. You will then be directed to the next page (step 3) where you can send additional photos.

Please make sure you click the “Send Your Questionnaire” button.

If you leave the page without sending, the form gets cancelled and anything you have entered will be lost.