Permanent Makeup Registration & Consent
Welcome to Rita Makmak Beauty! Please complete this form before your procedure today. Answer each question carefully so Rita can review your information with you before starting.
Please use the same email address you used when booking your appointment and double-check it for accuracy. We’ll use it to send your aftercare instructions and follow-up emails.
How did you hear about Rita Makmak Beauty?*
Please answer the following questions accurately and include any relevant details. Rita will review your answers with you before starting. If you’re unsure how to answer a question, please ask Rita.
Do you currently have, or have a history of, any of the following? Select all that apply. Select “None of the above” only if no other option applies.*
Have you experienced slow wound healing or problems healing after a cut, surgery, tattoo, or previous permanent makeup procedure?*
Have you ever developed thick, raised scars or keloids after a skin injury or procedure?*
Have you consumed any alcohol today?*
Have you consumed any caffeine today, such as coffee, tea, or energy drinks?*
Are you currently taking any blood-thinning medication, such as warfarin (Coumadin), Eliquis, Xarelto, Plavix, or daily aspirin?*
Have you recently taken aspirin, ibuprofen (Advil or Motrin), or naproxen (Aleve), including occasional doses for pain?*
Do not stop or change any prescribed medication for this procedure without guidance from your prescribing healthcare professional. Please discuss your answers with Rita before treatment.
Are you currently pregnant, or is there a possibility you may be pregnant?*
Are you currently breastfeeding?*
Are you currently wearing contact lenses?*
Have you had any face surgery or medical procedure that Rita should know about before today’s treatment?*
Do you have any known allergies or have you ever had a reaction to medications, numbing products (such as lidocaine), tattoo pigments, latex, adhesives, antiseptics, or skincare products?*
