Before your appointment

Let's evaluate your eyes

Please complete this form after booking and before you come in. It is how we get to know your eyes before we ever meet, so our specialist can review everything ahead of time and your appointment can begin with a treatment plan already in place.

Your information

Full name

Phone

How did you hear about us?

About your eyes

Current concerns (select all that apply)

Sparse lashes Asymmetrical eye shape Previous PMU or eyeliner tattoo Contact lens wearer None of the above

What are your eyeliner goals?

Current medications

Is there anything else about your general health we should know?

Upload your photos

Three clear, well-lit photos in natural sunlight — no flash, no filters, no eye makeup if possible.

Eyes open

Looking straight at the camera, eyes open

Choose File No file chosen

Eyes closed

Eyes gently closed, relaxed

Choose File No file chosen

Close-up of lash line

A close, well-lit shot of your lash line

Choose File No file chosen

Goal eyeliner (optional)

If you have a photo of your goal eyeliner style you'd like to share with us, feel free to upload it here. This section is not required.

Choose File No file chosen

Your photos and personal information are kept secure and confidential. Only authorized Youth Clinic staff have access to your files. This form is intended solely for pre-evaluation purposes and will not be used for any other reason — we are committed to protecting your identity and confidentiality.

Your photos and information go directly to our team — we'll review everything before your appointment.