Ombré Powder Brows Client Consent Form & Liability Waiver

Ombré Powder Brows Client Consent Form & Liability Waiver

For New Clients Only
I acknowledge by signing this release that I have been given the full opportunity to ask any and all questions which I might have about obtaining permanent make-up from BROWSBYCYNDO hereafter called Cynthia and that all of my questions have been answered to my full and total satisfaction.

Procedure to be performed: OMBRE POWDER BROWS
Name*

First NameLast Name
Age*
Email*
example@example.com
DOB*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Appointment Date*

MonthDayYear
Date
Referred By:
How did you find me? (Instagram, TikTok, Word of Mouth, Friends, Family, etc.)*

Studio Policy
The following statements are BROWSBYCYNDO policies and I agree to the following rules and regulations:

• I understand that no guests are allowed in the studio

• I understand that pricing is subject to change and that there are no refunds. No exceptions.

• I certify that I am aware of the company’s same-day cancellation/no-show policy and the rescheduling policy and that I will be charged the full-service amount if I am in violation of the policy. I understand that if I am more than 15 minutes late, my appointment will be canceled, and no refunds will be given. I understand that this applies to my future appointments.
I Agree to the Studio Policy
Deposit and Payment
Must be 18+ to book an appointment

Ombré Powder Brows: $50 deposit
All deposits are NON REFUNDABLE. A deposit must be sent immediately after booking. Appointment will be cancelled if no deposit is sent. Deposits will go towards your remaining balance.

Payment Options:

Venmo: @cyndo99 (emojis only, nothing service related)
Zelle/Apple Pay: (626)476-1284
Cash is acceptable for the remaining balance
I Agree to the Deposit and Payment Terms
I specifically acknowledge that I have been advised of the matters set forth below and agree as follows:

INITIAL EACH LINE:
Initial* I certify that I am over the age of 18 and that I have a U.S. government-issued ID to prove so. I am not under the influence of any drugs or alcohol. To my knowledge, I do not have any physical, mental, or medical impairment or disability that might affect my well-being as a direct or indirect result of my decision to have a tattoo at this time.
Initial* I acknowledge that obtaining permanent make-up is my choice alone. The application of permanent makeup will result in a permanent change to my appearance, and needles and inks will go into my skin. No representations have been made to me as to the ability to later restore the skin involved in permanent makeup to the original condition, and it is very costly to remove.
Initial* I certify that the following statements are true:
• I am not pregnant or breastfeeding
• I am not diabetic
• I do not have any history of herpes
• I do not have epilepsy
• I do not have any allergies to latex or antibiotics
• I do not have hemophilia or other bleeding disorders
• I have not used Accutane or prescription acne treatment within the last year
• I have not had laser tattoo removal within the last 4 weeks
• I have not gotten botox within the last 4 weeks
• I have informed the Technician if I suffer from hepatitis or any other bloodborne pathogen exposure or any other communicable disease.
• I have been advised of any medication and/or procedure necessary to promote the satisfactory healing of my tattoo
Initial* I do not suffer from any medical or skin condition(s) such as, but not limited to: keloid or hypertrophic scarring, psoriasis at the site of the permanent make-up, or any open wounds or lesions at the site of the tattoo. I do not have a history of medication use or currently using a medication, including being prescribed antibiotics prior to dental or surgical procedures. I have advised the Technician of any allergies to latex gloves, soaps, or medications. I acknowledge it is not reasonably possible for the Technician to determine whether I might have an allergic reaction to the permanent make-up process and further acknowledge that such a reaction is possible.
Initial* I acknowledge that infection, although rare, is always possible as a result of permanent make-up application, and I agree to follow all suggested instructions concerning the care of the permanent make-up site while it is healing.
Initial* I understand I will have permanent makeup applied using appropriate instruments and sterilization techniques. I understand that the permanent makeup site usually takes 4 weeks or longer to heal. I agree to release and forever discharge, and hold harmless, The Technician, all employees, contractors, and the management of the permanent make-up studio from any and all claims of negligence, damages, or legal actions arising from or connected in any way with my tattoo, the procedure, and conduct used in my tattoo and assume all responsibility or the decision(s) made consenting to this permanent procedure.
Initial* I am aware that permanent cosmetic inks, dyes, and pigments have not been approved by the Federal Food and Drug Administration and that the health consequences of using these products are unknown.
Initial* I acknowledge and give consent to this permanent make-up studio to use images of my tattoo(s) for marketing and, or publishing purposes in various media such as the internet, magazine, printed, and/or television, etc. I consent to allow photos and videos to be taken of me before, during, and after the procedure.
Initial* I acknowledge that the results of my permanent make-up service vary on several factors such as skin type, aftercare, skincare, sun exposure, etc., and that it is my full responsibility to follow the aftercare instructions provided in order to achieve the best results. I acknowledge that results vary and that they may not uphold my expectations. 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 and healing results. I acknowledge that all permanent make-up procedures may take more than two sessions to perfect.
Initial* I acknowledge that the Technician has the right to refuse service to any client who he/she deems unfit for the procedure. I authorize the technician as my permanent cosmetic technician to perform on my body. I am informed of my technician's qualifications and licenses.
I certify that I have read and fully understand the contents of this form. I understand that this consent applies to all my future appointments. I understand the risks inherent in the procedure and have the possibility of complications during and/or following the procedures such as infections, misplaced pigment, poor color retention, and hyperpigmentation. I authorize the technician as my permanent cosmetic technician to perform on my body.
Name*

First NameLast Name
Signature*
Date*

MonthDayYear
Date

Ombré Powder Brows Client Consent Form & Liability Waiver

Studio Policy

Deposit and Payment