Jesilyn Shambarger




Consultation Form

(Now Scheduling)

Getting started on your cosmetic tattoo begins with filling out the form below. I will review your answers and get back with you soon via email. In the meantime, please read my FAQ, Prep care, and Aftercare.

Contact Information

First and Last Name of person getting tattooed
Ph# is used to confirm your app. - not for consultations, sorry.
How old are you?

Cosmetic Tattoo Information

1. Please list any current medical conditions/disorders:

2. Please list any current medications and what you take them for: 

3. Have you ever taken Accutane or other acne medications? If yes, have you taken them in the past year?

4. Do you have any autoimmune disorders? (such as: diabetes, alopecia, celiac, arthritis, psoriasis or other)

5. Please list all known allergies:

6. Have you ever had a reaction to any dyes/pigments or cosmetics/makeup?

7. Do you have any sensitivities to anesthesia, such as Lidocaine? (Usually, you would know this if you have ever had an issue with numbing at the dentist.)

8. How would you describe your skin type? (Dry, normal, oily, combination, mature, scarred or textured)

9. How does your skin do with healing wounds? Do you scar very easily?

10. Have you ever had very thick/abnormal scar tissue, such as a keloid scar?

11. Have you ever had post-inflammatory hyperpigmentation on/around a wound? (The skin darkens around the wound)

12. If you have other tattoos, did they heal well?

13. Have you ever had your brows tattooed/microbladed before? If so, when was your last session, and how many total sessions have you had?

14. Please list any products that you use on your face:

15. If you have a skin care routine, please explain your process:

16. Do you regularly get facials, peels, microdermabrasion, electrolysis, Botox, waxing, threading, or any other services to the face?

17. What are your goals for your brows?

18. Please send me photos of your brows without makeup. (One photo straight-on of both brows & one of each brow from the side. You can also send me a photo of your brows with makeup so I can see how you normally do them.)

User Agreement

By checking this box I understand that I have read and accept the User Agreement.