Client Consent Form

1
Name* This field is required.
First Name
Last Name
2
Pronouns* This field is required.
Please Select
Please Select
They/Them
She/Her
He/Him
3
Email* This field is required.
example@example.com
4
Phone Number* This field is required.
Please enter a valid phone number.
5
Emergency Contact* This field is required.Name + Phone Number
6
Preferred Appointment Atmosphere* This field is required.What's your vibe?
Chat me up :)
SPILL THE TEA!
Shhhh...I want peace & quiet!
Playlist, pretty please!
7
Preferred Services* This field is required.Please select up to 2 services that you would like Throwing Shade LA to provide.
Microblading
Combination Browns (Microblading + Shading)
Ombre Brows (Only Shading)
Lamination, Wax + Tint
Henna Brows (No Wax)
Hybrid Tint/Stain (No Wax)
Wax + Shaping
Wax (ADD ON)
Lash Lift + Tint
8
Are you currently under the care of a physician?* This field is required.Please note if you have any medical conditions that may be impacted my permanent makeup, or may require you to obtain permission from your physician prior to receiving service.
Please Select
Please Select
Yes
No
If yes, please provide details. If no, input NA.
9
Photo ReleaseI consent to the use of my photo in social media posts or advertising materials.
10
Do have any of the following? * This field is required.Please check all that apply.
Sensitive Skin
Oily/Severely Oily Skin
Allergy to Latex
Allergy or Sensitivity to Products Containing "caines" (such as Lidocaine)
Allergy to Antibiotics
Allergy to Metals
Allergy to Pigmentation
Accutane Treatment
Allergy to Petroleum
Keloids
Eczema
Psoriasis
Dermatitis
Rosacea
Bleeding Disorder/Hemophilia
Heart Condition/Pacemaker/Defibrillator
Hepatitis B Virus
Glaucoma
Auto-immune Disease (i.e. Lupus)
Alopecia
Diabetes
Trichotillomania
Herpes Virus (cold sores or fever blisters on the area to be treated)
Thyroid Conditions
Tuberculosis
Cancer (Please specify on next page)
High Blood Pressure
Other (Please specify on next page)
11
Please list specifications or necessary details for any boxes checked on the previous page.* This field is required.Type NA if not applicable.
Huge
Large
Normal
Small
Ok
Ok
12
Are you under the age of 18?* This field is required.
YESNO
13
Are you allergic to any metal?* This field is required.
YESNO
14
Have you had a chemical or laser peel in the last week?* This field is required.
YESNO
15
Have you had permanent makeup procedures before?* This field is required.
YESNO
16
Are you pregnant, trying, or nursing?* This field is required.
YESNO
17
Have you consumed alcohol or drugs in the last 24 hours?* This field is required.
YESNO
18
Are you planning to have any facial plastic surgery?* This field is required.
YESNO
19
Have you had laser or saline removal of brows?* This field is required.
YESNO
20
Have you had an eyebrow transplant?* This field is required.
YESNO
21
Do you get Botox and/or fillers?* This field is required.
YESNO
22
Do you have any scars in the area to be treated?* This field is required.
YESNO
23
Are you a tobacco smoker?* This field is required.
YESNO
24
Have you had any complications with previous tattoos or permanent makeup?* This field is required.
YESNO
25
Have you ever had a facelift/forehead or brow lift?* This field is required.
YESNO
26
For ALL PERMANENT MAKEUP PROCEDURES: Please read the following facts and check the corresponding boxes to confirm that you have read, understood, and acknowledge each.A signature will be required on the next page. Please scroll to the bottom and SELECT "NOT Receiving Permanent Makeup" box if applicable.
I am over 18, I am not under the influence of alcohol, and I desire to receive the indicated permanent cosmetic procedure.
I acknowledge and understand that if I have oily/severely oily skin, the pigment will appear/heal much softer and can migrate due to over production of oil. The pigment WILL fade quicker, look blurred or migrate over time. I understand the risks and would like to proceed.
I realize that my body is unique and the artist cannot predict how my skin will react to the procedure.
All initial procedures often require two appointments and touch ups every 1-2 years; for microblading, every 2-3 years; for ombre or combo brows, every 3-5 years.
Results WILL appear softer as treated areas heal. The areas treated will not look as defined or as bold as the first procedure.
ALL PERMANENT MAKEUP RESULTS VARY FROM PERSON TO PERSON.
When you leave our office, the hair strokes are intact. How your body heals them is out of the control of the artist. This is 100% your body's job. Even when following the aftercare, fading, blurring or poor retention can still happen, depending on your skin type and lifestyle.
I have received pre and post procedure instructions, and I will strictly adhere to such instructions. I understand that my failure to do so may jeopardize my chances for a successful procedure.
I understand that if I do not abide by the strict aftercare, I can ruin my results. The aftercare is crucial for optimal pigment retention.
Permanent makeup is an ART, NOT a science. Clients results will vary and using a pencil or powder may or will still be needed. We have no control over your body's healing process and each time a procedure is done, the pigment will have less retention due to scar tissue.
I understand that if I get pregnant after my first appointment, touch up prices will be charged accordingly.
I understand that at a certain point as the skin ages, permanent makeup will no longer be an option.
I acknowledge that tattoo inks, dyes, and pigments have not been approved by the FDA and the health consequences are unknown.
I have been informed of the natural risks and possible complications and consequences of permanent skin pigmentation. I understand this procedure carries with it known and unknown complications and consequences including, but not limited to, infection, allergic reaction, scarring, inconsistent color, spreading, fanning, or fading of pigments. I understand the color of pigment may be modified slightly due to the tone and color of my skin. If I have any type of infection, rash, or condition that may affect the healing of this permanent makeup procedure, I will advise my artist. I fully understand this is a tattoo process, not an exact science, but an art. I am requesting the permanent skin pigmentation procedure and accept the permanence of the procedure, as well as possible complications of said procedure.
I understand that the taking of before and after pictures of the said procedures is a condition of such procedures. I certify that I have read the above paragraphs on this consent form and I accept full responsibility for the decision to have this cosmetic tattoo work done.
ABSOLUTELY NO REFUNDS after services are performed.
If you have tattoo removal prior to seeing your artist, due to the scar tissue, the pigment may not retain. Further procedures may not be an option, and I understand there are no refunds.
I understand that if I have any skin treatments, laser or saline removal, plastic surgery, or other skin-altering procedures, it may result in adverse changes to my permanent cosmetics. I acknowledge some of these potential adverse changes may not be correctable.
NOT Receiving Permanent Makeup
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I have read and fully understand the contents of each paragraph above. I acknowledge this is a legal and binding contract, and that I have received no warranties or guarantees with respect to the benefits to be realized from or consequences of, the aforementioned procedure(s). I further acknowledge that at the time of signing this consent to this procedure(s), I was of sound mind and capable of making independent decisions for myself.* This field is required.Please sign below.
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