Before your appointment

Let's evaluate your lips

Please complete this form after booking and before you come in. It is how we get to know your lips 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 lips

Skin type

Current lip concerns (select all that apply)

Uneven color or tone Thin lips or lack of definition Asymmetrical lip shape Previous lip blush or PMU History of cold sores None of the above

What are your lip 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 lip liner, lipstick, or gloss if possible.

Front-facing (relaxed)

Lips relaxed, no smile

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Front-facing (smiling)

A natural smile, showing your lip line

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Close-up of lips

A close, well-lit shot of just your lips

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Goal lips (optional)

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

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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.