MicroShading/Powder Consent Form

MicroShading/Powder Consent Form

Procedure MicroShading/ Powder

If you can't perform the complimentary touch-up due to your own scheduling conflicts, medical reason, become pregnant or do not show up for your appointment for whatever reason, a touch-up of $100 we be charged for touch-ups after 6 months depending on next appointment availability. ( add fee amount above)
Rate is subject to change. ( add initial above).
Informed Consent

The nature and method of the proposed cosmetic tattoo procedure has been explained to me as having the usual risks inherent in the procedure and the possibility of complication during and following its performance. I understand there may be a certain amount of discomfort or pain associated with the procedure and that other adverse side effects may include minor and temporary bleeding, bruising, redness or other discoloration and swelling. Fading or loss of pigment may occur. Secondary infection in the area of the procedure may occur, however, if properly cared for, is rare.

I also acknowledge that all of my questions have been answered to my full and total satisfaction. I specifically acknowledge that I have been advised of the fact and matters set below, and I agree as follows:
And I agree to accept the risk that such a reaction is possible.I have informed the practitioner of any existing problems. (add initial above)
The pigment WILL fade quicker, look blurred or more solid. I accept these risks and would like to proceed. (initial above)
I further understand that such changes are not the fault of the practitioner. I further understand that such changes in my appearance may not be correctable through cosmetic tattoo procedures. (initial above)
(Type APPROVE with initial above) (Type DECLINE with initial above).
THIS PROCEDURE AND THAR THE PROFESSIONAL RECOMMENDATION IS A NATURAL LOOK (initial above)
I understand the actual color of the pigment may be modified slightly due to the tone and color of my skin. (initial above.
Further procedures may not be option and I understand there are NO REFUNDS. (initial above)
We have no control over bodies healing process and each time a procedure is done, the pigment will have less retention due to scar tissue. Touch ups will not be done any sooner than the required time recommended by the technician. (initial above)
Are your pregnant, nursing or trying (IVF) to get pregnant? (If you circle, I don't know, services will not be performed)

I have read and fully understand the contents of each paragraph above. I acknowledge this is a legal & binding contract and that I have received no warranties or guarantees with  respect to the benefits to be realized from or consequences of, the aforementioned procedures(s). I further acknowledge that at the time of the signing this consent to this procedures(s), I was of sound mind and capable of making independent decisions for myself.

Confidential Medical Profile

To avoid unforeseen complications, please answer the following questions:

Are your over the age of 18?
Have you consumed alcohol today?
Have you had any aspirin or blood thinning products within the last 7 days?
Do have any history cold sores, herpes, or fever blister?
Any mood-altering drugs within the last 8 hours? (i.e Wellbutrin,Xanax, Prozac)
Are you sensitive to Latex?
Have you had a chemical or laser peel within the last 7 days?
Do you have a problem with healing?
Previous problems with tattoos or has your physician advised you not to have a tattoo at this time?
Are currently undergoing radiation or chemotherpy
Are you currently using Retin-A or "Alpha Hydroxy" skin care products? (If so, avoid use for 1 month following procedure)
Do you wear contact lenses?
Are you allergic to any metal?(e.g. Can only wear 14Kgold)
Have you ever had any cosmetic tattoo procedures done prior to us? Area? When?
Medications, including immunosuppressants such as anti-inflammatory or steroids?
Did you have caffeine products today?
Are you allergic to topical antibiotic numbing creams or desensitizers
Is there any history of skin diseases or remarkable skin sensitivites?
Are you taking any vitamins
Are you pregnant, trying or nursing?
Are you required to take antibiotics during dental or invasive medical procedures?
Do you have drug allergies? If yes list space provided at the end of the form.
Did you work out today?
How many times/week do you?

Practitioner makes no attempt to, or claim to, practice medicine. Some individuals will have complications related to permanent makeup application. These complications are usually mild and last only a few days. However, extreme complications are always a possibility. If you are healthy and there are no visible reasons restricting you from receiving a tattoo, you must approve of the design and color before the application of your permanent makeup.

Do you, or have had, any of the following:

Please explain any checked question, list any other medical conditions or allergies, and list your medications

Client Consent to be Photographed

Name
Name
First
Last
ONLY. Consent shall involve the use of my photos for any educational purposes, including instruction, display to professional organizations, website, social media and advertising thereof.

T

permission to use my photo/s as marked above.
Full Face (optional)
Eyebrows w/Eyes Only (must initial)

Eyebrow Aftercare Instructions

(To be followed for Original Procedure & ALL touch-ups)

After your eyebrow procedure, you may be swollen.  Some clients will swell minimally and some will swell more.  Everyone reacts differently. This can cause the area(s) to appear uneven, red, itchy and irritated when healing. The area(s) will also appear much darker and thicker than the final result.  You can expect eyebrows to fade any where from 10% - 50% this typically happens within 3-30 days of the first procedure.  There WILL BE some shedding of skin with color in it as the area heals. Do not pick. Some areas of the eyebrows WILL fade more than other areas and as the pigment oxidizes it will start to darken up a little over a 2 to 3 week period (this varies person to person).

Red heads, blondes & fair skin types, will experience more swelling, redness, crusting or scabbing and some area will fade substantially. There is a possibility of no retention. (initial below)
PIGMENT. IT WILL FADE SOONER, & MAY NOT TAKE

A pigment seal will be applied right after procedure and it will protect the area for 1st day. After the treatment rinse eyebrows first night only with neutral antibacterial soap provided. Next day apply ointment provided (a grain of rice amount) to brows in the (2 x a day) morning and evening for remaining 14 days. If you have oily skin, it is recommended to do dry healing instead(no ointment). If you should experience any scabbing, crusting, or flaking, please let it exfoliate naturally, do pick it. This will prevent any unnecessary infections or additional pigment loss.

If the area is still dry and flaky after the 14 days, you can continue the ointment for another 2-3 days. It is OK to wash the brows again after the 2 weeks, avoid scrubbing them.
It is standard procedure in our office is see our clients back 6-12 weeks after their original procedure for their complimentary touch up. This is necessary to fine-tune the treated area. After the touch up, it is recommended to refresh pigment again in 1-3 years to maintain the desired color.
Touch ups will not be done any sooner than 1 year from last appointment. No exceptions. All aftercare rule apply to all subsequent appointments as well.
When you leave the office, the brow are intact. How your body heals them is out of the control of the technician. This is 100% your bodies job. Even when following the aftercare fading, blurring or poor retention can still happen depending on your skin & lifestyle. This NOT the fault of the technican.
If you go elsewhere for any touchups after
Has done them, she will no longer do your procedures again.
COSMETIC Tattoo is an art, NOT a science. Client results will vary & using a pencil or powder will still be needed. We ave no control over your bodies healing process and each time a procedure is done , the pigment will have less retention due to scar tissue. Touch ups will not be done any sooner
ABSOLUTELY NO GETTING EYEBROWS DIRECTLY WET (WATER, POOL, OCEAN), SUN (HEAT), SWEATING (OF ANY KIND), HOT YOGA, SWIMMING, GYM/EXERCISE FOR 2 WEEKS  AFTER EACH SESSION. NO TANNING & RETINOLS/ANTI-AGING CREAM FOR  30 DAYS BEFORE THE PROCEDURE AND FOR 30 DAYS AFTER.
IF YOU DO NOT WAIT THE 14 DAYS, YOU WILL RUIN THE RESULTS. IF YOU DO NOT FOLLOW THIS AFTERCARE, WE WILL KNOW AND HAVE THE RIGHT TO RELEASE YOU FROM ANY FUTURE SERVICES. IF YOU WORK OUT REGULARLY, YOU RESULTS WILL NOT LAST AS LONG DUE TO THE SWEATING AND OILS THE BODY PRODUCES WHEN IT GETS HEATED/SWEATY.
I ACCEPT THESE RISKS & POSSIBILITY OF THIS HAPPENING.
COSMETIC TATTOO WILL APPEAR MORE SOLID AS YOUR SKING AGES & AT SOME POINT FUTURE PROCEDURES WILL NOT BE AN OPITION.

Precautionary COVID-19 Liability Release Form

Please read the form in its entirety and answer truthfully. If not cannot check each box (meaning yes) your appointment will need to be rescheduled at a time when all boxes can be checked off.

do hereby agree with and confirm that the following statements are true:
I have not traveled out of the country or to any COVID-19 hotspots within the past 30 days.
I have not had any symptoms of being sick, including cough, fever, sore throat, chills, or loss taste and/or smell in the last 14 days.
I am not living with or been in close promimity with anyone who has exhibited signs of being sick in the last 14 days or anyone who is quarantine and/or tested positive for COVID-19
I have checked my temperate prior to my appointment, and was below 100 F. I also aggrege to have contactless temperature check upon arrival appointment. Again, if you have a temperature above 100 F, your appointment will need to be rescheduled.
I will washed my hands with soap and water for 20 seconds before and after my procedure, as well as before and use of the bathroom.
Salon staff will ve wearing Personal Protective Equipment (PPE), including mask and gloves, throughout the duration of the appointment and I agree to wear a face mask as well throughout the duration if the appointment that I (the client) will provide.
I will maintain social distance of at least 6 feet from anyone in the salon, except during my procedure or any processess related to my procedure.
I understand that this procedure is an elective procedure and that I do not have to have any service done today. I understand tat I can reschedule my appointment for a later date at no cost to me.
I am aware that current COVID-19 pandemic means that I am at risk for becoming infected with te virus despite the staff best efforts at preventing the spread of infection and germs
I understand that the staff will be doing everything required by government and health officals to prevent the spread of COVID-19 but that information about preventing and spreading infection from COVID-19 is limited and continues to evolve and the risk of infection still exists.
I am choosing to undergo this procedure today despite the risk associated with COVID-19 and will not hold any owner, employee, or staff member for this facility liable for any exposure to the virus or any other contagion, or for any negligence if I become infected.
I understand that the staff will be disinfecting the work areas frequently, including before and after procedure, but that disinfectant can only kill 99.99% pathogens.
I agree that that only I, the client, will come to the appointment. No guest will be allowed in.
I agree to bring only what is necessary for appointment and to not bring food and/or drinks to my appointment.
If I notice any symptoms of infection, such as cough or fever, within 14 days of having this procedure done, I will contact my physician and inform the artist who performed my procedure.

By signing below, I affirm that the above statements are true and hereby release all staff members and artists from any and all liability for the intentional expose or harm due to COVID-19.

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Patch test
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Bleeding
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