Rejuvabrow Medical Form

Company Declaration:

Benito are hereby registered for the business of Semi-Permanent and Microblading services and for the premises Liverpool Benito Brow Bar (Debenhams Liverpool) above to be registered for the carrying out of the business of Semi-Permanent skin and Microblading services. All inspections have been carried out and approved by Liverpool City Council.
Personal Information
Your name (both fields required)*
First Last
Email*
Date of birth*
DD slash MM slash YYYY
Address (all fields required)*
Street Address Address Line 2 Town/City County / State / Region Post Code
Have you had permanent services before*
- Please Choose
- Yes
- No
How long ago was your last treatment?*
Do you know anyone who has permanent cosmetics?*
- Please choose
- Yes
- No
How long have you been thinking about having the treatment?*
Why do you want the treatment?*
Where did you first learn about permanent cosmetics?*

Company Declaration: