cathi.ink corp Permanent Cosmetics Contact Form

Info on this form is privacy protected

The only person receiving and viewing this form is fine artist and CEO, Cathi Locati. Information you provide is never shared with anyone, ever. Upon submission of this form, a HIPPA protected file is created for you at cathi.ink corp and maintained throughout your Micropigmentation process. Thank you for your trust. Required fields must be filled in to create the best picture of you for your consultation with Cathi.

Today's Date*

New client Name*

What is your ethnicity / nationality?*

For ink matching purposes, please select from the dropdown, if other...please describe below.

Select or enter value

Describe OTHER ethnicity

SCHEDULE your free first consultation with Areola Architect Cathi Locati

Cathi will make every effort to reach you on one or the other dates and times you list below. If she is unavailable to schedule your first consultation at either of those times, she will call you during the best part of the day when you might be available...

Morning / Afternoon for Intake Session?*

What is the best part of the day to reach you in general?

Select or enter value

First choice date to call you to discuss form:*

1st choice time to call:*

Second choice date to discuss form:*

2nd choice time to call:*

Who may we thank for referring you to us?*

who referred you?

If you used Google to find cathi.ink...

which key words, phrases did you use? What path did you follow to find the website?

eMail address*

cell phone #:*

Second number other than cell, home # or family #

Street address*

City where you live*

State you live in*

Zip code*

Date of Birth*

Your current age*

Current medical condition:*

Select or enter value

In your own words - what do you seek?*

Ready, set, go?*

Please indicate if are you ready for Micropigmentation now within the next week or two. If you are not ready yet, please indicate a time in the future when you feel you will be ready.

What is your NATURAL hair color?*

Skin color*

What is the condition of your skin?*

Do you have a regular tattoo?*

If you have a regular tattoo...

did you have any adverse affects from it? Did you experience any issues with rashes or other problems? Please explain:

Do you have diabetes?*

If you have diabetes....

please provide the name and contact info of your primary care provider for a medical release:

Please select Micropigmentation service:*

Select or enter value

Select additional service:

Select or enter value

Attach photos of face

If you would like Cathi to review your current situation for assessment, using the file attachment upload link below this question, attach a clear, sharp focus photo of your face, eyebrows.

File Attachments

Drag and drop files here or

Anything else you would like to add?

Thank you!

You have created a client portrait for Cathi to best understand the picture of you during your consultation session over the phone. Cathi is looking forward to speaking with you about gorgeous full-color fine art solutions in permanent ink that will last forever. Cathi will call you asap once you have submitted this form.

Send me a copy of my responses

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