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Medical & Skin History

Please fill out this form before your Appointment at the RKBTA studio. All fields are required.

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Are you pregnant/nursing?
Do you wear contact lnses?
Do you have any allergies?
Are you allergic to any metals (Nickel, etc.)?
Are you prone to developing keloids?
Do you have any tattoos?
Have you got any semi-permanent makeup procedre before?
Are you taking any medcation, including immunosuppressants, anti-inflammatories, or steroid?
Are you allergic to any topical antibiotics/anesthetics?
Are you taking any mediations, including vitamins, or Aspirin, etc.?
How would you define your skin?
Do you currently have any blemishes, cuts, irritation, or infections on your face?
Do you have any moles, raised areas, prior or current piercings in the projected procedural area?
Do you have Eczema, Psoriasis around the eyes, or have you had a recent eye surgery?
Do you have diabetes?
Do you have oily skin conditions?
Do you have a vascular or cardiovascular condition?
Have you had any recent medical procedures?
Have you got lash extensions in the last 14 days?
Have you received Botox injections in the last 30 days?
Do you use skincare procedures with Retin-A, Retinols, or Vitamin A?
Have you had any facial procedures in the last 30 days?
Have you sunbathed or used a tanning bed in the last 2 weeks?
Have you ever been diagnosed with cancer? If yes, are you currently getting any treatmnent for the same?

Thanks for submitting!

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