New Guest: Microblading

Now please attach a photo of your brow area. Make sure you're makeup-free and the photo is taken in a well-lit area. We will inform you if you need to send another photo. Thank you for your patience and cooperation. We will notify you shortly if you are a candidate for this procedure.

Consent and Release Agreement

This form is designed to give information needed to make an informed choice of whether or not to undergo a 3D Eyebrow, Microblading, semi-permanent makeup application. If you have any questions, please don’t hesitate to ask.

Although 3D Eyebrow Microblading is effective in most cases, no guarantee can be made that a specific client will benefit from the procedure

This is the process of inserting pigment into the basal layer of the epidermis. It is a form of tattooing, though semi-permanent, it is considered a permanent marking.

All instruments that enter the skin or come in contact with body fluids are disposable, and disposed of after use. Cross contamination guidelines are strictly adhered to.

Generally, the results are excellent. However, a perfect result is not a realistic expectation. It is usual and advised to expect a Touch-Up after healing is completed.

Initially the color will appear more vibrant or darker compared to the end result. Usually within 5-7 days the color will fade 40-50%, soften and look more natural. The pigment is semi-permanent and will fade over time. Additional Touch-Ups are likely needed within 6 months to 2 years.

Photography Release Consent

We would like your permission to use these photos for advertising. For example: Portfolios, online and print ads, etc. Your consent is necessary regarding this. Please circle and indicate with your signature if you would like your photos used or not used in advertising.

Possible Risks, Hazards, or Complications

Pain

There can be pain even after the topical anesthetic has been used. Anesthetics work better on some people than others.

Infection

Infection is very unusual. The areas treated must be kept clean, and only freshly cleaned hands should touch the areas. See after care.

Uneven Pigmentation

This can result from poor healing, infection, bleeding, or many other causes. Your follow-up appointment will likely correct any uneven appearance.

Asymmetry

Every effort will be made to avoid asymmetry, but our faces are not symmetrical so adjustments may be needed during the follow-up session to correct any unevenness.

Excessive Swelling or Bruising

Some people bruise or swell more than others. Ice packs may help reduce the swelling. The swelling or bruising typically disappears in 1-5 days. Some people don't bruise or swell at all.

Anesthetics

Topical anesthetics are used to numb the area to be tatoooed. Lidocaine, Prilocaine, Benzocaine, Tetracaine, and/or Epinephrine cream and/or liquid are used. If you are allergic to any of these, please inform us.

MRI

Because pigments used in Permanent Cosmetic Procedures contain inert oxides, a low level magnet may be required if you need to be scanned by an MRI machine. You must inform your MRI Technician of any tattoos or permanent cosmetics.

Allergic Reaction

Although an allergy is unusual, there is always a possibility of an unknown allergy to the pigments and materials used during the procedure.

The alternative to these possibilities is to use traditional cosmetics and NOT undergo the Semi-Permanent Eyebrow Procedure.

Statement of Consent and Recitals: Please read all lines.

Aftercare instructions have been explained to me and a written copy has been given to me to retain in my possession, which I will follow to the best of my ability. If I have questions, I will call or email you.

I understand that a certain amount of discomfort is associated with this procedure, and that swelling, redness and bruising may occur.

I understand that although the European technique performed correctly, is considered semi-permanent since it fades and exfoliates out with the skin over time, strokes and markings are considered permanent by nature and by the Health Department.

I understand that Retin A, Renova, Alpha Hydroxy and Glycolic Acids must not be used on treated areas. They will alter the color and cause premature exfoliation of the pigment.

I understand that tanning beds, pools, some skin care products and medications can affect my permanent makeup.

I understand that successful color saturation can NOT be guaranteed due to hidden scar tissue.

I will tell all skin care professionals or medical personnel about my permanent makeup procedures, especially if I am scheduled for an MRI.

I accept the responsibility to explain to you by desire for specific colors, shape, and position for any procedure done today.

I understand that implanted pigment color can slightly change or fade over time due to circumstances beyond your control, and I will need to maintain the color with future applications and a touch-up session within 60 days.

I acknowledge that the proposed procedures(s) involve risks inherent in the procedure, and have possibilities of complications during and/or following the procedures such as: infection, misplaced pigment, poor color retention, hyper-pigmentation, scarring, bleeding, & nerve damage.

I have been advised that a touch-up session is highly recommended to make any adjustments to shape, color, and to fill any pigment that may have had poor retention. Touch- ups must be completed within 60 days of initial procedure.

I have been quoted the cost of today’s appointment, and the cost of the touch-up. Touch-ups must be completed within 60 days of initial procedure to be considered a touch-up price.