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Name
First Name
Last Name
Address
Street Address
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City
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Date
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Month
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Day
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Date
Appointment
Service
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Makeup Application
Waxing
Brow lamination
Microblading
Powder Brows
Combination Brow
I hereby declare that I have been informed in detail about the method and procedure which will be performed. I was informed that needles are used for the treatment to inject color pigments into the upper layers of the skin.
I am aware that this isn't possible to predict how durable and intensive the brow color will be and that the durability and color intensity depend on age, skin type, and environmental conditions of he treated person.
I am aware that treatment with the pigmenting needles can cause skin irritation and minor inflammation of the skin which usually disappears within 24-36 hours.
I have been informed that the pigments will appear darker within the first few days immediately following the procedure that the final result. it will be necessary to undergo follow-up treatments.
Allergies?
I authorized the use of my photographs taken by the technician to be used on social media and shown to potential clients.
I have Informed that Medicines affects different individuals in different was just a side effect occurred in some cases, it does not mean they will occur to me. some common side effects anesthetics may include. (allergic reaction light headaches, drowsiness/dizziness, vomiting, numbness of the tongue, unusual slow heartbeat)
During the first & days after treatment I should not. *expose the treatment area to UV rays. * use the sauna or swimming pool. * use make up other than the recommended after are products.
Furthermore, I stated that: I am not diabetic/ not hemophiliac/ do not test positive for HIV or Hepatitis Viruses/ I am not pregnant or breastfeeding.
I have informed the technician of any medication I am currently taking, which may affect blood coagulation during the Embroidery procedure these include: Blood thinner, blood pressure medication, diuretics, pain killers, Dermatological mediation,(Accutane, Chemical peels and Antibiotics)
I hereby declare that I am not intoxicated and that I am fully aware of the treatment procedure and that I understand the above statement to be true. I give my consent to have the procedure performed and assume full responsibility for the outcome. I do not and will not hold the technician responsible or liable should the results may not be discussed or as I imagined.
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