• Microblading Statement of Consent & Release Agreement

  • Format: (000) 000-0000.
  • Birthday*
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  • I certify that I am 18 years or older*
  • Before Microblading Session

    Learn more about Microblading
  • Microblading results create amazing looking eyebrows, however the procedure is not recommended for everyone. To prevent any complications relating to your overall well being, please review all the information below: microblading requirements; contraindications; and medications to avoid before your appointment.

    Proper preparation for a microblading appointment will also help to achieve the best possible healed results, so be sure to prepare accordingly.

    *Appointments typically last 2 to 3 hours; babies or children can't be present during your appointment, so please make necessary arrangements in advance.

    *Please come to an appointment wearing your makeup as you normally do. By doing so, it helps in communicating the desired color preference of your eyebrows. 

  • REQUIREMENTS BEFORE EYEBROW MICROBLADING:

    • No Botox treatments should be done 3 weeks prior or 4 weeks after procedure
    • No chemical peels 60 days before or after procedure (brows will peel quicker due to chemicals traveling under the skin)
    • No Retinols/Retin-A or other anti-aging/acne creams, or serums containing acids as these will fade brows prematurely
    • Do not work out or sweat heavily the day of the procedure (or 2 weeks after)
    • Do not tan or have a sunburned face the day of the procedure
    • No waxing or tinting 3 days before procedure
    • Stop taking aspirin, niacin, vitamin E, fish oil, CoQ10 and ibuprofen 48 hours before procedure
    • No alcohol or caffeine 24 hrs before procedure
  • MICROBLADING CONTRAINDICATIONS
    MICROBLADING IS NOT RECOMMENDED FOR ANYONE WHO IS OR HAS THE FOLLOWING:

    • Sick with cold, flu, or sinus/respiratory infection (please reschedule your appointment and stay home to recover)
    • Skin irritations including: sunburn, rash, eczema, shingles, acne, or psoriasis near the treated area
    • Pregnant or nursing
    • Under age 18
    • Had Botox within 3 weeks from scheduled appointment
    • Used Accutane in the past year
    • Diabetes
    • Epilepsy
    • Undergoing chemo
    • Prone to keloid scarring
    • Pacemaker or major heart problems
    • Had an organ transplant
    • Viral infections and or diseases
    • Transmittable blood disease, HIV or Hepatitis
  • Medical History

    • In order to perform the procedures in a safe manner, please answer the following questions truthfully.
  • Are you pregnant or breastfeeding?*
  • Do you currently have or have you ever had any of the following medical conditions?*
  • Have you ever had Herpes (Cold Sore)?*
  • Have you ever had any of the following procedures done?*

  • Are you allergic to any of the following?*

  • Are you currently using any of the following medications?*

  • AFTERCARE

    Microblading from Lia Lacerda makes the creation of perfect eyebrows possible, but to ensure that you get the naturally beautiful looking brows you want, following the Microblading Aftercare Instructions is essential.

    ***FAILURE TO FOLLOW AFTER-CARE INSTRUCTIONS MAY RESULT IN SCARRING, INFECTIONS, PIGMENT LOSS OR DISCOLORATION.

    DAYS 1-10:

    • Wash the microbladed area twice per day. 
    • At the start and end of each day, use your clean fingertips and a mild antibacterial soap, like Cetaphil, to gently cleanse your eyebrows for 10-15 seconds.
    • Avoid using any cleansing products that contain exfoliants or acids (glycolic, lactic, or AHA).
    • Keep in mind the cleansing shouldn't be a thorough scrub-down, it just needs to be done by rubbing the microbladed area in a soft, smooth manner.
    • When rinsing, be sure to rinse every trace of soap from the microbladed area.
    • Dry the entire eyebrow area completely by blotting it with a clean tissue.

    THINGS TO AVOID:

    ***It's critical to avoid the following for 14 days after your microblading procedure.

    • Touching the microbladed area without washed hands.
    • Scratching, picking or peeling the microbladed area, as it can cause scarring and/or color loss.
    • Applying any makeup, moisturizer, lotion, or sunscreen to your eyebrows.
    • Sun exposure - sun tanning - salon tanning
    • Laser or chemical peels, and any other form of exfoliation.
    • Exercise - participating in sports and activities that induce perspiration
    • Long, hot baths or showers - jacuzzis - saunas - swimming
    • Applying any creams to your face or neck containing retinol or glycolic acid.
    • Engaging in tasks like heavy household cleaning where airborne debris can become prevalent.
    • Drinking excessive amounts of alcohol, as it can cause wounds to heal slower.
    • Transportation in open-air-vehicles where strong wind is likely, for example; driving in cars with windows down, convertibles, motorcycles, bicycles, and boats.

     

    Keep your eyebrows dry and clean.

    Avoid contact with water. A thick crust will appear and all the pigment will fade.

    Do not touch the scab in any other case except while cleaning.

    For post treatment care, only use recommended products to clean the eyebrows (sterile water for the first day only).

    If skin is oily or sweaty make sure to clean it when necessary (witch hazel if needed).

    In the first two weeks after the treatment avoid swimming pools, sunbathing, tanning beds (no sun or tanning for 30 days), sauna, beauty treatments, and intense training accompanied by sweating (sport activities), and avoid contact with dirt/dust.

  • PROCEDURE EXPLANATION

    This form is to give you information needed to make an informed choice of whether or not to undergo an Eyebrow Microblading, Lips Micropigmentation and Semi-Permanent makeup application.If you have any questions, please don’t hesitate to ask.
    Although 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.
    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.


    PAIN: I understand that a certain amount of discomfort is associated with this procedure, and that swelling, redness and bruising may occur. There can be pain even after the topical anesthetic has been used. Anesthetics work better on some people than on others.


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


    EXCESSIVE SWELLING or BRUISING: I understand that some swelling and bruising may occur. 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.


    SKINCARE: 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.


    TANNING + SUN EXPOSURE: I understand that tanning beds, pools, some skin care products and medications can affect my permanent makeup.


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


    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.


    UNEVEN PIGMENTATION: 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 4-6 weeks. This can result from poor healing, infection, bleeding, or many other causes. Your follow-up appointment will likely correct any uneven appearance.


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


    BROW COLOR + SHAPE: I accept the responsibility to explain to you my desire for specific colors, shape, and position for any procedure done today.


    INFECTION + COMPLICATIONS: I acknowledge that the proposed procedures 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 and hyper-pigmentation. Infection is very unusual. The areas treated must be kept clean, and only freshly cleaned hands should touch the areas. See “After Care” sheet for instruction on care.


    TOUCH-UP: I have been advised that a touch-up session is recommended to make any adjustments to shape, color, and to fill any pigment that may have had poor retention. It is not necessary, just if you really need. Touch-ups must be completed within 4-6 weeks of initial procedure.


    COST: I have been quoted the cost of today’s appointment, which includes one (1) touch-up appointment that must be completed within 4-6 weeks of initial procedure to be considered a touch-up price. There will be no refunds for this/these elective procedure(s).


    ALLERGIC REACTION: There is a small possibility of an allergic reaction.

     

     

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  • Appointment Cancellation Policy

    Please give us 24 hour notice of any change or cancellation of your appointment. Missing an appointment without notifying us will result in a cancellation fee of 50% on all services reserved. This cancellation policy allows us us the time to inform our stand by clients of any availability, as well as keeping our technician’s schedules filled, thus better serving everyone.

    Client Acknowledgement

    I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read, and fully understand the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the risks and alternatives involved in this procedure and that it is my sole responsibility to notify the technician of any changes to the above information before any service. I understand the procedure and accept the risks. I do not hold Lia Lacerda or Natura Spa responsible for any of my conditions that were present, but not disclosed at the time of this procedure, which may be affected by the treatment performed today.

  • Today's Date*
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  • Client Signature*
  • Lia Lacerda Signature
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