• Re-Consent Form For Touch Up Visits

    I absolutely understand and accept that the touch up procedure is a process, often requiring multiple applications of color to achieve desirable results and that 100% success cannot be guaranteed.

  • PLEASE READ AND INITIAL ALL OF THE FOLLOWING BOXES... (please be advised that we absolutely can not treat you if you are pregnant or nursing, under the age of 18 without parent consent, have had any kind of organ transplant or lupus. 

  • I have received, reviewed, and understand the pre & post-procedural instructions as given to me and agree to follow them.

  • Depending on the procedure(s) which I select, I accept responsibility for determining the shape, and position of eyebrows, eyeliners, lip liner and/or full lip color.

  • I understand that the color selection and color results in all procedures are not an exact science.

  • Iunderstand that positioning of my procedures can be affected if I have elected or wish to elect cosmetic surgery, Botox or Restalyne and I assume this responsibility.

  • I am aware that if I am to receive an MRI after the procedure, I must tell the Radiologist that I have iron oxide permanent cosmetics (tattoo When asked if you have a tattoo, you say yes.

  • 10. I realize this is an elective cosmetic procedure, not an exact science, and is not medically

  • 12. I understand that many lasers & IPL's (Intense Pulse Lights) including those used for hair removal, anti-aging, Photo Facials, removal of lines; may or will turn permanent makeup dark or even black. I agree to inform my esthetician or anyone operating such devices that I have permanent make

  • 13. I give my consent to BROWHAUS STUDIO, Andrea Cerini, LLC, to confer with my physicians for medical information required for the safety of my procedures.

  • 17. Are you Pregnant? Yes []No []

  • 18. Is your Health History the same as your last visit? Yes []No [

  • ACCEPTANCE: I have read and understand these risks listed above and they have been explained to me. I DID NOT JUST SIMPLY SIGN THIS DOCUMENT WITHOUT READING IT. I certify that the information in the above questionnaire is accurate and my questions have been answered. I accept full responsibility for any complications that may arise or result during or following the cosmetic procedure(s) to be performed at my request. Touch Up pricing honored for 3 months after procedure. Thereafter, touch up price is subject to increase.

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