PMU Consent & Appointment Request
Which service are you interested in booking
Microblading
Ombre Powder Brow
The Vilansse Signature Combo Brow (Most Popular)
Brow Wax and Tinting
15 Minute Phone Consultation
Brow Reshape/Fix/Reconstruct
Other
Client
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Last Name
Phone Number
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Format: (000) 000-0000.
Email
example@example.com
*If requesting Semi-Permanent Brow Service - Please add a picture of your eyebrows with NOTHING on them and a Photo of the Eyebrow style you're interested in*
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This is REQUIRED
Cancel
of
Preferred Appointment Request Date (ONLY Confirmed After Confirmation with Technician)
By checking the following boxes, confirm that you willingly consent to the following terms and conditions: ONLY for Semi-Permanent BROW Requests*
I have been informed of the nature, risks, and possible complications and consequences of semi-permanent skin pigmentation.
I understand the semi-permanent skin pigmentation procedure carries with it known and unknown results based on skin type, lifestyle, and overall health. Light scarring, inconsistent healed color, and spreading, fanning or fading of pigments can happen.
I understand that a SECOND appointment will be REQUIRED in 8 weeks
I understand the actual color of the pigment may be modified slightly, due to the tone, color, and condition of my skin.
I will follow the post-treatment home care instructions and understand how important it is to follow all instructions given to me for post-treatment care.
I understand that my photos may be used in marketing material and am offering consent. (Please let technician know if you're not comfortable)
By checking the following boxes, confirm that you willingly consent to having the treatment during the new strain of the COVID-19 pandemic:
I am aware of the risks of having hair services during the pandemic.
I understand that physical distancing of 6 feet may not be possible while in the salon receiving services.
I will follow the rules in order to minimize the spread of viruses. I understand that I must sanitize my hands before entering the salon and I must wear a mask that covers my mouth and nose while in common areas.
I confirm that I have not travelled domestically or internationally via public transportation within 14 days.
I do not have any of the following COVID-19 symptoms: cough, shortness of breath, high fever, muscle pain, body ache, nausea, loss of taste, loss of smell.
I have not contacted with anyone that have or may have COVID-19 symptoms or get infected within past 14 days.
I verify that the information I have provided on this form is truthful and accurate. I have read, understand, and checked all the terms and conditions. I release the beauty studio, stylists, officials, workers, stakeholders, members, and all of the parties related to the beauty studio from any and all of the claims and demands including damages, diseases, and or injuries.
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