I certify that I am over the age of 18.

 

I have voluntarily elected to receive this enhancement service after the nature and purpose of this treatment have been explained to me.

 

I understand and acknowledge that there are risks involved with the treatment I will be receiving. Although it is impossible to list every potential risk and complication, I have been informed of possible benefits, risks, and complications, and I have had the opportunity to ask questions regarding these risks and other possible complications.

 

I understand that even though my technician uses the proper technique, the instruments, as a part of the procedure, supplies, instruments, and products could cause eye irritation, pain, itching, discomfort, infection, blurriness could occur. Should any of these things happen I will notify my technician right away and consult a physician at my own expense.

 

I acknowledge that there are no guaranteed results and that independent results differ for a variety of reasons including, but not limited to, age, skin condition, and lifestyle, and that there is a possibility I may require further treatments to obtain the expected results at an additional cost.

 

I have read and understand the pre-care and post-care instructions and understand that failure to follow said instructions will alter the longevity and/or health of my lashes or brows. I have read and understand the contraindications and medications that preclude me from being an ideal candidate for this procedure and have, to the best of my knowledge, given an accurate account of my medical history, including all known allergies, prescription drugs, or products I am currently integrating or using topically.

 

 

 

BY SIGNING BELOW, I GIVE MY CONSENT AND AGREE TO THE FOLLOWING:

I have read the contents of this whole form and fully understand this agreement and all the information detailed above. I understand what the procedure entails and accept the risks. I give permission to my esthetician to perform the waxing procedure we have discussed, and I will hold Punahele Kaai (Piha Beauty and Esthetics, LLC) harmless from any liability that may result from this treatment. I agree I will assume the risk and full responsibility for any, and all injuries, losses, side effects, or damages which might occur to me while I am undergoing this procedure. I do not hold Punahele Kaai (Piha Beauty and Esthetics, LLC) responsible for any of my conditions that were present, but not disclosed at the time of this procedure, which may be affected by the treatment performed today.

I certify that I am over the age of 18.

 

I have voluntarily elected to receive this body sculpting service after the nature and purpose of this treatment have been explained to me.

 

I understand that body sculpting can be used to reduce fat deposits but it is not intended to be a weight loss solution. I understand that results are not guaranteed, will vary from client to client, and may require more than one session.

 

I understand that performing this procedure may have side effects. Although it is impossible to list every potential risk and complication, I have been informed of possible benefits, risks, and complications, and I have had the opportunity to ask questions regarding these risks and other possible complications.

 

I have read and understand the pre-care and post-care instructions. Should I have any additional questions or concerns regarding my treatment and at-home care, I will consult my technician immediately.

 

I have read and understand the contraindications and medications that preclude me from being an ideal candidate for this procedure and have, to the best of my knowledge, given an accurate account of my medical history, including all known allergies, prescription drugs, or products I am currently integrating or using topically.

 

 

 

 

BY SIGNING BELOW, I GIVE MY CONSENT AND AGREE TO THE FOLLOWING:

I have read the contents of this whole form and fully understand this agreement and all the information detailed above. I understand what the procedure entails and accept the risks. I give permission to my esthetician to perform the waxing procedure we have discussed, and I will hold Punahele Kaai (Piha Beauty and Esthetics, LLC) harmless from any liability that may result from this treatment. I agree I will assume the risk and full responsibility for any, and all injuries, losses, side effects, or damages which might occur to me while I am undergoing this procedure. I do not hold Punahele Kaai (Piha Beauty and Esthetics, LLC) responsible for any of my conditions that were present, but not disclosed at the time of this procedure, which may be affected by the treatment performed today.

I certify that I am over the age of 18, am not under the influence of drugs or alcohol and desire to have Powder Ombre of my eyebrows performed.

 

I certify that the general nature of cosmetic tattooing as well as the specific procedure to be performed has been explained to me.

 

I have been informed of the nature, risks, and possible complications and consequences of permanent skin pigmentation. I understand the permanent skin pigmentation carries with it known and unknown complications and consequences associated with this type of cosmetic procedure, including but not limited to: infection, allergic reaction, scarring, inconsistent color, and spreading, fanning, or fading of pigments. I understand the actual color of the pigment may be modified slightly, due to the tone and color of my skin. I fully understand this is a tattoo process and therefore not an exact science, but an art. I request the Powder Ombre Brow procedure and accept the permanence of the procedure as well as the possible complications and consequences of the said procedure. I understand that while this is sometimes referred to as semi-permanent in nature, due to everyone's reaction to pigment, the length of time the pigment is present cannot be guaranteed. In some cases, pigment will be permanent.

 

I understand that if I have any skin treatments, laser hair 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.

 

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. If I am on any medication for depression or any other mood altering prescription, I will advise my technician.

 

I understand that the taking of before and after photographs are a condition of such procedure.

 

In the event that I may have additional questions or concerns regarding my treatment and aftercare, I will consult my technician immediately.

 

I understand that a certain amount of discomfort is associated with this procedure, and that swelling, redness, and bruising may occur.

 

I understand that Vitamin A, Retin-A, Vitamin C, Renova, Retinol, Alpha Hydroxy Acids, and Glycolic Acids must not be used on the treated areas as it will lighten the color and case premature exfoliation of the pigment.

 

I understand that tanning beds, pools, some skin care products, and medication can affect my permanent makeup.

 

I understand that successful color saturation can NOT be guaranteed due to hidden scar tissue.

 

I accept the responsibility to explain to you by desire for specific colors, shape, and placement for any procedure done today.

 

I have been advised that a touch up session is not required but highly recommended to make any adjustments to shape, color, and to fill in any pigment that may have had poor retention. Touch ups must be completed within 4-12 weeks of initial procedure.

 

I understand that any medical information obtained will be subject to the federal Health Insurance Portability and Accountability Act of 1966 (HIPAA).

 

I have also, to the best of my knowledge, given an accurate account of my medical history, including all known allergies or prescription drugs or products I am currently integrating or using topically.

 

 

Possible Risk, Hazards, or Complications:

Sanitation: All instruments that enter the skin or come in contact with body fluids are disposable and disposed of after use. Cross contamination guidelines are strictly adhered to.

Pain: There can be pain even after the topical anesthetic has been used. Anesthetics work better on some people than on others.

Infection: Infection is very unusual. The areas treated must be kept clean, and only freshly cleaned hands should touch the areas. Aftercare instructions will be provided for you.

Uneven Pigmentation: This can result from poor healing, infection, bleeding, or many other causes. Your follow up appointment will likely correct any uneven appearance.

Asymmetry: Every effort will be made to avoid asymmetry, but our faces are not symmetrical so adjustments may be needed during the follow up session to correct any unevenness.

Excessive Swelling or Bruising: Some people bruise or swell more than others. Ice packs may help reduce swelling. The swelling or bruising typically disappears in 1-5 days. Most people don't bruise or swell at all.

Anesthetics: Topical anesthetics are used to numb the area being tattooed. Lidocaine, Prilocaine, Benzocaine, Tetracaine, and or Epinephrine cream or liquid are used. If you are allergic to any of these, please inform your technician.

 

Generally, the results are excellent. However, a perfect result is not a realistic expectation. It is usual and advised to expect a touch-up after healing is complete. Initially, the color will appear more vibrant or darker compared to the end result. Usually within 7-10 days, the color will fade 30%-40% softer and look more natural. The pigment is semi-permanent and will fade over time. Any additional touch ups may be needed within 6 months to 2 years depending on client's skin type, lifestyle, etc.

 

I hereby release any and all persons representing Piha Beauty and Esthetics, LLC from all responsibility. I accept and all responsibility for any consequences that might arise from my decision to have tattoo work done by Piha Beauty and Esthetics, LLC. I agree not to sue or make any claim against Piha Beauty and Esthetics, LLC in connection with any and all damages, claims, demands, rights, and causes of action of whatever kind of nature based upon injuries or property damage, or death to myself, or any other person arising from my decision to have tattoo related work done at this time, whether or not caused by any negligence of Piha Beauty and Esthetics, LLC.

I agree for myself, my heirs, assigns, and all legal representatives, to hold Piha Beauty and Esthetics, LLC harmless from all damages, actions, causes of actions, claims, claim judgements, cost of litigation, attorney fees, and all other costs and expenses from my decision to have any tattoo work done by Piha Beauty and Esthetics, LLC.

 

 

 

BY SIGNING BELOW, I GIVE MY CONSENT AND AGREE TO THE FOLLOWING:

I have read the contents of this whole form and fully understand this agreement and all the information detailed above. I understand what the procedure entails and accept the risks. I give permission to my esthetician to perform the waxing procedure we have discussed, and I will hold Punahele Kaai (Piha Beauty and Esthetics, LLC) harmless from any liability that may result from this treatment. I agree I will assume the risk and full responsibility for any, and all injuries, losses, side effects, or damages which might occur to me while I am undergoing this procedure. I do not hold Punahele Kaai (Piha Beauty and Esthetics, LLC) responsible for any of my conditions that were present, but not disclosed at the time of this procedure, which may be affected by the treatment performed today.