_____I hereby authorize Haja Sow to perform upon myself permanent cosmetic enhancement. If any unforeseen condition arises in the course of the procedure(s), I further request and authorize Simply Arched Microblading to use its full judgment and do whatever is deemed advisable and necessary in the circumstances without any liability to Simply Arched Microblading.
_____ I understand that semi-permanent and permanent cosmetic enhancement is an advanced form
of tattoo.
_____ I accept full responsibility for determining the color, shape, and position of the enhancement as mutually agreed upon during the course of my consultation.
_____ I understand that a commercially reasonable effort will be made to avoid unevenness, but some bone structure, facial deformity or birthmarks, or muscle movement does not call for perfect symmetry.
_____ I am aware of that allergic response to pigment is rare and accept all responsibility if allergic response occurs.
_____ I understand that employee(s), practitioner, or any personnel from Simply Arched Microblading are not licensed physicians or medical doctors and was made aware to seek a licensed physician or medical doctor’s opinion if needed.
_____I am aware that a sensitivity reaction to anesthetics can occur and accept all responsibility if allergic response occurs.
_____ I fully understand and accept that non-toxic pigments are used during the procedure and that the cosmetic enhancement achieved may fade over the course of 1 to 2 years. Even though the color has faded, the pigment will stay in the skin indefinitely and may leave a light residue of color on the
skin.
_____ I understand that dyes, inks, and pigments are not approved by the Food and Drug Administration (“FDA”), and the health effects are not known.
_____ I accept that the highest standards of hygiene are met, and that sterile disposable needles are used for each individual client, procedure, and visit.
_____ I understand and accept that each procedure is a process requiring multiple applications of pigment to achieve desirable results and that 100% success cannot be guaranteed. I understand that this is why I may need to return for a touch-up procedure or additional touch-ups thereafter.
_____I understand that the touchup procedure, if required, will be performed 4 weeks to 4 months after the initial procedure, and that after the 4 months period, I will be charged an additional fee for any procedures or services. I will book an appointment when it is convenient for both parties.
_____ I understand that all services are non-transferrable and non-refundable (full or partial refund).
_____ I understand that semi-permanent cosmetic enhancement is an invasive procedure, and theinfusion process can be uncomfortable or sometimes painful depending on my sensitivity.
_____I am aware that the result of the procedure is determined by the following:
*Medication A compromised immune system
*Skin Characteristics - i.e. dry/oily/sun-damage Poor Diet
*Natural skin undertones Post procedure care treatment
*Alcohol intake and smoking Lifestyle
*General stress Sun Exposure
_____I have been advised that upon completion of the procedure there may be swelling and redness of the skin, which will most likely subside within 1 to 2 days dependent on lifestyle or any factors listed above. In some cases, bruising can occur.
_____ I have been advised that I can resume normal activities immediately following the procedure, however, using cosmetics, prolonged exposure to water, excessive perspiration, and exposure to the sun should be limited for up to 2 weeks following the infusion process.
_____ I understand that immediately after the procedure, the enhancement may be 40% to 60% darker than the desired result and may take between 4 to 10 days to lighten.
_____ I understand that the true color will be visible approximately 1 month after each application, and that the color may vary according to skin tones, skin type, age, and skin conditions.
_____ I acknowledge that some skins accept color more readily than others, and no guarantee of an exact effect or color can be given.
_____I acknowledge that the proposed procedure(s) involve inherent and unforeseeable risks in the procedure and have possibilities of complications during and/or following the procedure(s) such as: infection, misplaced pigment, poor color retention and hyper-pigmentation.
_____ I understand that there are few effective methods for pigment removal. Laser removal has proven successful, however is a process, which may take some time.
_____ I have been quoted the cost of today’s procedure and understand that future touch-up rates and/or policies are subject to change.
_____ I agree to follow all pre-procedure and post-procedure instructions as provided and explained to me by the practitioner, employee, or contractor of Simply Arched Microblading I understand that infection and possible scarring can occur if I do not adhere to the said instructions.
_____ I understand that Simply Arched Microblading can release me as a client at any given time with or without a reason.
_____ I understand that Retin A, Renova, Alpha Hydroxy, Glycolic Acids, Aloe, and Vitamin E products must not be used on the treated areas or forehead area during healing.
_____ To my knowledge I do not have any physical, mental, or medical impairment or disability that might affect my well being as a direct or indirect result of my decision to have the procedure done at this time.
_____For the purpose of documentation, I also consent to the taking of “before” and “after” photographs of said procedure(s). I give my consent for before and after pictures to be used for marketing.
_____ I understand that the Gwinnett County Board of Health makes no guarantee that there will be no injury due to the aforementioned procedure being performed. Furthermore, Gwinnett County Board of Health assumes no liability for any injury which may occur.