New Customer Registration Form

Customer Details
Date*

MonthDayYear
Date
Full Name*

First NameLast Name
Phone Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Birthday*

MonthDayYear
must be 18+
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about us?
Feedback about us:

Microblade Contraindications

Before continuing please be sure you have NO contraindications listed below that will keep you from receiving our microblade service.
- You are under 18 years of age
- You have diabetes (medical clearance)
- You are pregnant or breastfeeding
- You have glaucoma
- You are taking blood thinning medicines (medical clearance)
- You have healing disorders (medical clearance)
- You have uncontrolled high blood pressure
- You are on any skin medications such as accutane/steroids
- You have active skin cancer
- You are undergoing radiotherapy or chemotherapy (medical clearance)
- You have epilepsy
- You have pacemaker or major heart problems
- You have a trasmittable blood condition such as HIV/Hepatitis
- You have had Botox in the last 3 weeks
Balance Esthetics is obligated to perform procedures in strict compliance with all hygiene and health protection measures. This information is confidential and will be handled that way. Balance Esthetics assumes no liability in any case of giving false information.

Contractual Obligations

In order to receive microblading from Balance Esthetics below obligations must be checked and agreed upon.
CANCELLATION POLICY: Balance Esthetics has a strict 48 hour cancellation policy due to the length of the microblading appointment. By scheduling an appointment the client understands and agrees to all cancellation policies. Appointments may be cancelled or rescheduled as long as this is done within 48 hours prior to the service. If the client cancels or reschedules or if the appointment is missed within the 48 hours, the client understands they will be responsible for a fee of $100 dollars.PHOTO CONSENT: The client gives consent to Balance Esthetics on taking and using photos for social media advertising and marketing purposes.TOUCH UPS: Follow up perfecting session should be done anywhere from 6/10 weeks after your initial treatment. Any additional touch ups after that time period are an additional charge.PRICING: All pricing are subject to change. The client understands the current pricing.
The microblade service is a two appointment process. At the first microblade appointment the cost of service the client is charged is $375. The second microblade service will be scheduled anywhere from 6 to 10 weeks after the intial appointment. At the second microblade appointment the cost of service the client is charged is $75.
$450 Microblading + 6/8 week perfecting session included. -For new clients

$450 Combo Blade/Shade + 6/8 week perfecting session included. -For new clients

$250 Annual Touch Up/Color Boost. Must be performed within the annual time of the initial microblade or last color boost. - For returning Balance Esthetics clients
Signature*

Clear

Customer Details

Microblade Contraindications

Client Health Questionnaire

Contractual Obligations

ACKNOWLEDGEMENT/ WAIVER OF LIABILITY