PMB MODEL APPLICATION

APPLY HERE TO BE A PMB PROCEDURE MODEL...
Full Name *

First Name Last Name
E-mail *
Phone # *

Area Code Phone Number
AGE: *
Referred By: *
Please note full name if referred by Friend or Family. If found via websearch - please specify!
Please mark any/all that apply.

I am UNDER 18 years old. I have Oily Skin I am Allergic/Sensitive to Lidocaine I am Allergic/Sensitive to Latex I have been pregnant in the last 12 months I am currently Pregnant I am currently Breastfeeding I am undergoing Hormone Replacement Treatments I have a Thyroid condition I frequent Tanning Beds I use exfoliating facial products daily I wear contact lenses I use prescription skin care treatments I am taking blood thinning medication I have a blood borne illness I have uncontrolled high blood pressure I have had previous Permanent Makeup ( IF YES, PLEASE USE NOTES TO TELL US WHICH PROCEDURE, HOW LONG AGO, AND EXACTLY HOW MUCH COLOR REMAINS ) I am Diabetic I am currently using eyelash enhancing serums, or I have in the last 6 months I have been on Accutane in the last 12 months. I have had shingles on my face
Please mark all statements as acknowledgement.

I understand that being a model means a student (under very close supervision) is providing my services. I understand that if selected, I am committing to two appointments, that are on pre-set dates and times. I am ok with a professional picking the style of brow that is best for my skin type, face shape, and preference. (Hairstrokes, Powder, or Combo Brow options available) I am ok with a professional picking the style of eyeliner that is best for my me. I understand that cropped images may be shared socially, and that full face images will be used for classroom purposes. I understand that procedures are done in a classroom setting with observers.
I am Interested in *

Eyeliner/Lash Enhancement Brows
I am Interested in *

Being a Student's Model for an upcoming class Being an Instructor Demo for an upcoming class. Training to become a Cosmetic Tattoo artist
Please List ALL Medications, Vitamins, and Supplements you regularly take. Certain medications can affect the healing and/or procedure itself. Please Include all prescription and over the counter medications.
Please attach a BRIGHT,CLEAR, MAKEUP-FREE photo of your brows. Please do not send blurry photos. It is typically best to have someone else take the photo for you. *
Signature *

I have answered questions honestly and to the extent of my knowledge. I understand that not being forthright and honest with my medical history and background could negatively affect my procedure outcome. I agree to the policies of Permanent Makeup Boise, available to me at www.permanentmakeupboise.com . Clients who have had procedures performed by another technician will be charged the full price, according to the normal fee schedule, regardless of the procedure. We reserve the right to refuse any service or procedure. Clear
When you've completed the form you can SUBMIT ONLINE by clicking "SUBMIT" below.
Your information will go directly to Permanent Makeup Boise. If needed, a technician will call you for additional information.
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APPLY HERE TO BE A PMB PROCEDURE MODEL...