Client Intake & Consent | Studio Kypris

Preview form—information entered here is not saved yet. Required questions are marked *.

01 · CLIENT INFORMATION

About you

First name *Last name *Email *Mobile phone *Date of birth *PronounsHome addressEmergency contact name and phone *

02 · APPOINTMENT

Your treatment

Which service are you receiving? *

Have you previously received permanent makeup or tattooing in this treatment area? *

Yes No

What result are you hoping to achieve?

03 · MEDICAL HISTORY

Health and healing

Select every item that currently applies or has been diagnosed. These answers help determine whether treatment should proceed, be modified, or require medical clearance.

Other diagnosed conditions, surgeries, or relevant medical history

Are you pregnant, trying to become pregnant, or breastfeeding? *

Yes No Not applicable

04 · MEDICATIONS & ALLERGIES

Products that may affect treatment

List all current prescriptions, over-the-counter medication, vitamins and supplements. Enter “None” if none. *List allergies or sensitivities, including latex, lidocaine, pigments, adhesives and lash products. Enter “None” if none. *

Have you ever had an allergic or unexpected reaction to permanent makeup, tattoo pigment, topical anesthetic, adhesive, tint or lash-lift products? *

Yes No

05 · RECENT TREATMENTS & SKIN

Before your appointment

Provide dates and details for anything selected above.

Is the treatment area currently free of open wounds, active acne, rash, infection and significant irritation? *

Yes No

06 · CONSENT & ACKNOWLEDGMENTS

Please review carefully

07 · ELECTRONIC SIGNATURE

Sign and submit

Typing your legal name and submitting this form records your electronic signature, submission time, and the consent version attached to this appointment.

Full legal name *Today's date *

You may be contacted if an answer requires clarification or medical clearance.