CLIENT CONSENT FORM

Full Name*

For your artist use only

Phone*

Format: (000) 000-0000.

Email*

example@example.com

Date of Birth*

Date

Occupation*

How did you hear about us?*

Are you currently under the care of a doctor or hospital specialist? If yes, please list the relevant details of your Doctor and condition:*

Please list any medication you are taking*

YESNO

Please note that if you fail to disclose your previous Microblading/tattoo prior to arriving to your appointment and we can not work on your brows/lips , your appointment will be cancelled and you will be charged 50% service fee. If you have previous Microblading/tattoo on brows lips or eyes please note that correction work may require additional touch ups as skin quality can be compromised and there might be scar tissue underneath the pigment. Results are never guaranteed. Additional touch up price is $200 for each procedure.

YESNO

NOIf YES name condition

YESNO

NOIf YES what kind?

YESNO

NOIf YES Please add last treatment date below

I understand the importance of my accurate and complete medical history. And that withholding any medical information may be detrimental to my health and safety during the procedure. I understand that if there is any change in my medical history that it is my responsibility to advise my specialist.

Signature*

Before and after instructions will be explained orally and a written copy will be given to me to retain in my possession which I will follow to the best of my ability.*

I understand that permanent makeup outcome cannot be guaranteed. There are so many variables (medications, skin care routine, lifestyle, aftercare etc related to each client that affect the outcome of any permanent makeup procedure.*

I understand that implanted pigment can turn color or fade over time due to circumstances beyond the control of the performing technician and alter the original pigment color.*

I understand that I will need to maintain color with future applications.*

Sun, skin care products, pools, and other factors can contribute to pigment fading.*

I understand and accept all risks and possible complications that may arise from this procedure.*

I understand that eyebrows will look up to 40% darker and 20% thicker right after*

I acknowledge that touch up is not included in the initial price and it costs $200. Touch up has to be done between 5-10 weeks from my original appointment and it is my responsibility to schedule that touch up.*

I understand that perfect symmetry is not always possible because of the negative impact of facial expression. Symmetry might be corrected with permanent makeup but botox can be advised to correct it.*

I hereby consent to having permanent makeup applied by Karolina Bula Artistry *

I acknowledge that the proposed procedure(s) involve risks inherent in the procedure and the possibility of complications during the procedure. Those complications can be, but are not limited to, infections, poor color retention, or hyperpigmentation.*

I have answered all questions truthfully and to the best of knowledge. *

I understand that I can have an allergy reaction to any products used during the procedure.*

Patch test can be done but does not guarantee that a reaction will not occur, even years later.*

I certify that I have read and understand all of the above.*

I understand that there will be no refunds after treatment of this procedure. I understand that my payment covers the initial application and I might need touch up within 30-45 days from the initial application that will cost $200. I understand that I might need additional touch ups to achieve desired results and each touch up cost $200. It is the responsibility of the client to contact the technician to schedule a touch up. I understand that my touch up cannot be done earlier than 5 weeks from original appointment and if it's done later than 12 weeks it will be priced as Color Boost appointment which costs $350.

Signature*

Last minute cancellations hurt small businesses.

Please note that we have 48 hours cancellation and 15 min late policy.

If you decide to cancel with less than 48 hours notice or if you no show to your appointment it will result in charge of full cost of service.

You may also be required to rebook and pay a new deposit if you wish to continue with your procedure after arriving late or providing a short notice cancellation.

Please note that if you fail to disclose your previous Microblading/tattoo prior to arriving to your appointment and we can not work on your brows/lips , your appointment will be cancelled and you will be charged 50% service fee.

Please note that if we can not agree on shape/ style for your brows during the appointment we can decline to service you. Every artist have their specific style. Karolina custom draws the shape for every client that suits their face. She also suggests proper technique based on clients skin type/ their current brow shape etc. It is important that you put faith in the process of designing the brows shape based on your facial symmetry, muscles etc.

I have read and agreed to the terms of the above office policy.

Signature*

Date*

Date

Karolina Bula Artistry

MEDICAL HISTORY

POLICY