Microblading Client Consent Form

Full Legal Name

Date of Birth

Date

Mobile Number

Format: (000) 000-0000.

Occupation

Email Address

example@example.com

Residential Address

Where did you hear about us?

Please answer all questions to the best of your knowledge

Rows	Yes	No
Do you have easy or frequent bruising?
Are you taking recreational drugs?
Do you have thyroid complications?
Do you get eczema?
Are you allergic to latex or powder in gloves?
Do you have epilepsy or seizures?
Do you wear contact lenses?
Do you keloid? (Scar tissue overgrowth)
Have you ever had chicken pox?
Do you do any regular physical activity or exercise?
Do you experience cold sores or fever blisters?
Do you have any Botox, fillers or cosmetic implants?
Do you have diabetes, lupus or any other auto-immune disorder?
Do you have cancer or are undergoing chemo/radiation therapy?
Are you allergic to Novacaine/any Cain anesthetic/Eniprine?

Please list all current medications:

Please list all allergies:

I am requesting the Microblading Permanent Makeup Procedure at Blade+Shade Beauty Bar.

I acknowledge I will need a touch-up appointment 4-8 weeks after the initial appointment to ensure the best results and retention.

Client Full Nome

Signature

THE UNDERSIGNED hereby acknowledge that the permanent makeup procedures I will receive at Blade+Shade Beauty Bar, being performed by (Morgan Stout trained artist,) are voluntary and I agree to the procedure out of my own free will. I fully understand that the permanent skin pigmentation procedure is for cosmetic purposes only and should not be construed or be intended for any medical treatment and/or plastic surgery.

Accordingly, I hereby acknowledge that I fully understand and have been given sufficient opportunity for discussion to have any questions answered about the permanent make-up procedures to be performed by Morgan Stout with Blade+Shade Beauty Bar.

I ACKNOWLEDGE further that I have received adequate information to give my informed consent and authorize the artist to perform all permanent makeup procedures listed. In the event that I may have additional questions or concerns regarding my treatment I will consult Blade+Shade Beauty Bar, and or its technicians immediately.

I also hereby gront my consent for Blade+Shade Beauty Bar to use any or all before and after photos taken of the permanent makeup procedures conducted by Blade+Shade Beauty Bar for record purposes, and further give my permission to use any reproductions or adaptations of the photos for publicity or other purposes. This might include (but is not limited to the right to use them in printed and online marketing, social media, press releases and advertising applications.

Client's signature

I UNDERSTAND and acknowledge that this procedure is a process, and additional appointments after the initial procedure are necessary in order to achieve the desired results and will be subject to charge at additional rates. I understand the treatment procedures and accept the risks. Blade+Shade Beauty Bar LLC.'s products and technicians will at all times maintain acceptable high standards during procedures and will strive to provide the best possible result. I do however acknowledge and understand that my technician cannot predict the results in advance and that no guarantees have been made to me concerning the results of this procedure including, but not limited to, how the pigment will heal, shape changes or pre-mature fading.

I CONFIRM that I declared all known allergies, prescription medication, conditions, treatments or products I am currently ingesting or using topically and agree to follow the pre- and post-procedure instructions I received and will strictly adhere to such instructions. I understand that my failure to do so may compromise my chances for o successful procedure. I will not hold Blade+Shade Beauty Bar LLC. and/or the artist responsible for any of my conditions that were present, but not disclosed ot the time which may be affected by the procedures performed. I understand that withholding information or providing misinformation may result in contraindications and/or inritation from the procedures received.

Client's signature

I UNDERSTAND that correcting or touching up permanent make-up that was performed by other companies and or individuals other than Blade+Shade Beauty Bar LLC.'s artists, with Blade+Shade products, involves risks because of the existence of permanent pigments of unknown composition, brand, color, age, shape and other factors over which my technician has no control. Accordingly. I hereby indemnify and hold Blade+Shade Beauty Bar LLC. its artists and or agents harmless against any loss, damage, expense and/or liability which I may suffer as a result of any other permanent make up conducted by another third party.

I CONFIRM further that I have received, read and understand the above paragraphs, pre and post care and consent form and am agreeing to the requested service. I understand that signing below indicates my agreement to all of the conditions and provisions stated in this document.

Client's signature

By signing this agreement I hereby indemnify and hold harmless Blade+Shade Beauty Bar LLC. its employees, agents or any other person related to and or trained by them, for any damage or harm that may arise out of any procedure performed by them to me, whether such injury or domage or loss is coused by the negligence, acts or omissions of Blade+Shade Beauty Bar LLC. or any of its employees or agents or by any other cause whatsoever.

Client's signature:

Blade+Shade Artist’s Full Name

MICROBLADING CLIENT HISTORY & CONSENT FORM

Medical History

Approval + Consent of Permanent Makeup Procedure