Pre-Care Form

Name

First NameLast Name

Email

example@example.com

Phone Number

Area CodePhone Number

Appointment Date

Date

Hello Dear!

Thanks for your interest in booking an appointment for eyebrow services at ILASH CT.

Let’s make sure you are a good candidate for micropigmentation and help you understand what to expect. We want to make sure you get great results, which also requires that you follow appropriate pre- and post-care instructions.
It is very important that you read ALL of the information in this document, sign it, and send it back to us. This confirms that you understand our policies.

Contraindications

You are Not a candidate for micropigmentation if any of the following apply to you:

Pregnancy
Nursing
Diabetes (Physician's note is required)
Lupus
Hepatitis B/C
Active Skin Disorders: Cold Sores, Shingles, Impetigo, Psoriasis, Pink Eye, Sun Burn, Severe Acne
Active Vitiligo
Severe Rosacea
Blood Disorders: Sickle Cell, Hemophilia
Keloid Formation
Accutane (must be off for 6 months)
Steroids (must be off for 6 months)
Blood thinners
Inmune disease (Physician's note required)
Undergoing chemotherapy, radiation
Very oily skin (large pores, acne)- powder brows or shading is recommended
Skin conditions, such as: eczema, rosacea, psoriasis, keratosis pilaris and dermatitis (your skin is constantly flaking, itching, shedding constantly, or aggravated)

Do any of the contraindications described above apply to you?*

NoYes, (If yes, describe)

How to prepare for service?

It all starts with a good canvas! The eyebrow area must be healthy, strong, non-sensitive, and non-irritated. To get your skin ready for the procedure:

Do NOT pick/tweeze/wax/perform electrolysis 1 week before the procedure.
Do NOT tan 1 weeks prior to the service, or have a sunburned face
Do NOT have any type of facial service 4 weeks prior to the procedure
Do NOT work out the day of the procedure
Do NOT wax your eyebrows at least 7 days prior to service
Do NOT tint your eyebrows 4 weeks prior to the procedure so we can see the actual eyebrow hair color.
Do NOT have Botox 3 weeks prior and 3 weeks after the procedure

Before Service:

Please make sure you read the following instructions to assure the best results for your procedure:

Avoid alcohol, caffeine and drugs 1 day before procedure to minimize any bleeding or swelling.
Do not take aspirin, ibuprofen, niacin, fish oil or vitamin E 3 days prior to procedure unless medically necessary. Please consult with your Physician prior to booking.
Avoid working out or sweating for 1 week post procedure. (Sweat will lighten the pigment because it has salts and salt is a form of tattoo lightening.)
Retinol / Retin-A/ Retinoids must be discontinued 3 weeks prior to procedure. (It will cause the skin to bleed).
Injections (Botox, Radiesse, JuvaDerm, Voluma, etc.) must be done 4 weeks before or 4 weeks after procedure.
Chemical peels and laser treatments may not be done within 60 days before or after procedure.
Sunburned or Suntanned skin is damaged skin and therefore will cause excessive bleeding. We CANNOT work on sunburned or suntanned skin. Sun exposure causes fading and may change the color of the pigment.
You cannot expose the area to the sun for 10 days before or after procedure.
Stay out of steam rooms, saunas, hot yoga, swimming pool, etc. for 10 days following procedure.

Are you able to follow the above above instructions prior to service?*

NoYes, (If yes, describe)

Are you able to notify us 7 days prior to your appointment if plans change and you need to reschedule the appointment? A cancellation fee applies if notice is not given.*

NoYes, (If yes, describe)

What to expect after service?

Micropigmentation is a process. Multiple sessions may be required to achieve the desired results. It is not uncommon to lose up to 50% of the color after the first session.

The brows are darker and bolder in the width than they will be when healed. Your skin is red under the pigment which causes the color of the pigment to appear darker. There is some swelling, although difficult to actually see due to the thickness of the skin in the eyebrow area. This will subside. Exfoliation, which begins in a few days, will cause the excess pigment surrounding the eyebrow procedure to flake away and a narrower appearance of your eyebrows. Do not pick and do not be concerned that your eyebrows initially appear darker and heavier in size than you desire. This is all part of the process.

This is a cosmetic tattoo and with time, pigments may fade or change according to metabolism, lifestyle, skin type, medications, age, smoking, alcohol, sun exposure, and the use of chemicals such as Retin-A and Glycolic acids and laser treatments.

POLICIES:

No refunds
This is a tattoo process and therefore not an exact science, but an art. If for some reason my pigment does not stay or needs more touchups, I agree to contact my technician regarding additional applications at an additional cost. I am fully aware that no refunds will be received.

Cancellation
We are reserving 3-4 hours specifically for you. We require a deposit in order to reserve this time for your appointment. If you need to cancel for any reason, we require that you cancel no later than 7 days prior to the start of your appointment time. If your appointment is cancelled with less than 7 days’ notice (or in the case of a no-show), you will forfeit your deposit and a new deposit will be required to rebook. A cancellation fee applies if the retouch is cancelled with less that 7 days’ notice. Please note, retouch appointment expires after 8 weeks from initial appointment.

Tardiness
If a client is more than 15 minutes late, the procedure will be cancelled, and a new deposit will be required. Half of the service fee will still apply, as we are not able to sell this time to another client. Being late compromises the amount of time the artist has to spend on your procedure, which in turn compromises your results.

Client Only
It is important the artist is able to have their full focus on you, the client. Visitors tend to be a distraction for both the client and artist. It is against the insurance to have visitors in the working area. Thank you for your understanding.

We reserve the right to refuse service
The technician at ILASH CT reserves the right to refuse treatment if the client didn’t follow precare, client is under the influence of drugs or alcohol or client shows inappropriate behavior.

For more information, please review our Policies.

I First Name Last Name understand that cosmetic tattooing is an art form and NOT an exact science, and I acknowledge that no guarantees have been made to me as to the result of this procedure. I understand that some skin types will not accept or heal pigment in a consistent manner. Skin is unique and its practitioners cannot in any way predict how my skin may react to the procedure or how it may or may not accept color. I also realize that the technician cannot predict how many visits it will take to complete my procedure. Additional fees apply for each visit.

Signature

Clear

After-care instructions will be discuss at the time of the service.

Please call or email me with any other question you may have.

We look forward to seeing you soon!

ILASH CT