So High Brow- Health History

  • So High Brow- Health History

    Complete this form prior to your Eyebrow, Eyeliner and/or Lipblush appointment.
  • Format: (000) 000-0000.

  • So High Brow  is committed to and has implemented many safeguards to ensure its devices, services, websites and data systems (collectively “Products”) are compliant with the regulations and conditions set forth in the Health Insurance Portability and Availability Act of 1996 (HIPAA). So High Brow does not anticipate receiving or disclosing any individually identifiable information in the normal course of providing services. All collected information will be stored electronically in a secure environment inaccessible by any persons other than the technician. Documents are retained for minimum of 3 years and up to 7 years.

  • Health History - Does any of the following apply to you? Check all applicable boxes*
  • Are you taking any Prescribe or over the counter medication or vitamins?
  • Are you taking any over the counter or prescription Blood Thinners (e.g. Ibuprofen, Aspirin, etc.)?*
  • Do you have any allergies to Latex?*
  • Are do have any other allergies?*
  • Skin Type / Skin Care- Are you or have you had any of the following. Check all applicable boxes*
  • Do you have any other health information that I should be aware of that was not collected above?

  • So High Brow-Permanent Makeup Risks & Complications

    Please take time to read this form carefully so you understand possible risks and complications with semiperment make up.

  • ANESTHESIA: Topical anesthetics are used to numb the target area. Lidocaine, Prilocaine, Benzocaine, Tetracaine, Epinephrine, etc. in a cream or gel are typically used.

    PAIN: Even after topical anesthetic has been used, there can be some discomfort/pain.
    Anesthetics’ effectiveness will depend on each person.  

    ALLERGIC REACTION: There is a small chance of an allergic reaction. You may take a 5-7 day patch test. Schedule your patch test with your artist ASAP. Patch test fee is $20.00. If you choose to waive the patch test, sign here   *   

    EXCESSIVE SWELLING/ BRUISING: Some individuals bruise more easily than others. Ice packs will reduce swelling, typically lasting 2-5 days. Some people do not experience any swelling or bruising.

    INFECTION: Although unusual, infection can occur. The affected area must be kept clean and hands must be washed prior to touching. See “After Care Instructions” for more details

    ASYMMETRY: Every effort is made to make brows as symmetrical as possible, but faces are not symmetrical. Adjustments may be necessary to correct any appearance of unevenness.

    UNEVEN PIGMENTATION: This can result from poor healing, infection, bleeding or multiple other causes. Your touch-up appointment(s) will help correct uneven areas. Please schedule the touch up session within 6-8 weeks. Additional fee may apply if beyond 8 weeks.

    MRI: Pigments used in permanent cosmetic procedures may contain inert oxides. This may require a low level magnet when getting an MRI scan. You must inform medical personnel about your cosmetic tattoo. Please sign here   *   

  • So High Brow-Permanent Makeup Waiver & Release

    Please read each statement carefully and sign at the bottom of the form.

  •   I understand that this process involves pigment being inserted into the dermal layer of the skin and is a form of tattooing. This is effective in most cases, but there is no guarantee that a specific client will benefit from the procedure.

       I’m informed that all instruments that enter the skin or come in contact with body fluids are disposable and are disposed of after use. Cross contamination guidelines are strictly adhered to.

       I am informed of potentially harmful or negative side effects that may be caused by this process and release the Technician from all liability associated with this procedure. See “Risks and Complications” form.

      I acknowledge that some risks of this procedure may result in, but not limited to: pain, infection, uneven pigmentation, asymmetry, excessive swelling, bruising, and allergic reaction. If I have any questions, I will contact the Technician ASAP.      

       I am informed that the color will initially appear darker, compared to the end result. The color will fade 40-50% within a week and will soften/look more natural.

       During the first 14 days after the procedure, while the affected area is healing, and I understand that following the Post-care instructions is very important. A copy has been avaible to me via So High Brow LLC's website, which I will follow to the best of my ability.

       I understand that Retin-A®, Renova®, Tretinoin, Alpha Hydroxy and Glycolic acids must not be used on the treated areas. These products may alter the color.

       I understand that tanning beds, sunbathing, pools, some skin care products and medications can affect the results.

       I will tell all skin care professionals and medical personnel about my permanent makeup procedures, especially if I schedule an MRI.   *   

       I understand that generally, results are excellent. However, a perfect result is not realistic, and a touch-up within 6-8 weeks is necessary to achieve the best results.

       I have been quoted the cost of today’s appointment, which does not include a touch up required 6-8 weeks after the initial session.  There will be no refunds for this elective procedure. A non-refundable deposit  is required for booking. Touch up session is not free and it is my responsibility to schedule my appointment in a timely manner. Waiting longer than 8 weeks from the initial appointment is considered a color boost. Color boost fee will apply.   *   

       I give permission to So High Brow LLC to show my before and after photos and/or videos to other potential clients (e.g. Facebook, Instagram, company website, etc.)            

       I accept the responsibility for my explanation of desired color/shape/placement and understand this form is designed to give me the information needed to make an informed choice to undergo the procedure at So High Brow LLC.

       I acknowledge that the pigment is semi-permanent and will fade over time. Another touch-up will likely be needed within 6-18 months. Please note that color may fade faster on oily skin.

       I understand the risks associated with permanent makeup and I was provided an informational sheet in the previous page that I have review and signed separately.

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