• SEMI-PERMANENT EYEBROWS

    CLIENT CONSENT INTAKE FORMS
  • CONSULTATION FORM

    GENERAL INFORMATION
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • What is your gender?*
  • Date of birth: *
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  • PERSONAL HEALTH HISTORY

  • Is this the first time receiving permanent makeup?*
  • Please indicate any of the following treatments you have had in the past year?*
  • Do you have a history of any of the following medical conditions:*
  • Have you had any allergic reactions to any of the following?*
  • Are you currently pregnant or nursing?*
  • Do you have any allergies?*
  • Are you currently taking any medications including blood thinners?*
  • Do you use tanning beds or spend regular time in the sun?*
  • Have you ever had any adverse reactions to any previous treatments?*
  • Have you exfoliated or applied any products to your face in the last 24 hours?*
  • Please list your skin type:*
  • Certain conditions may affect how appropriate the treatment is. Please declare all relevant history as some conditions contraindicate the treatment.

  • CLIENT CONSENT FORM

  • Permanent Makeup or Cosmetic Tattooing is a technique that applies permanent pigment into the dermis (skin) that allows a desires look to be achieved that resembles makeup. It can also be used to hide scars or help with an uneven hairline. This is performed under a sterile environment.

    Permanent makeup uses iron oxides that pigments the skin. This pigmentation can last between 1-5 years. The Pigment will gradually fade over time, However for the most people it will not fade completely. “Touch ups” of permanent makeup are advised usually after 6-8 weeks in order to achieve desired results.

    With every treatment there are risks involved. It is important that you understand the risks prior to undergoing treatment. Ensuring you provide a full medical history can reduce these risk ,but even so there may be unforeseen risks that are presented. If you have any concerns regarding these risks, do not hesitate to contact your Healthcare Professional.

  • RISKS, COMPLICATIONS & CONTRAINDICATIONS
  • You are NOT a candidate for micropigmentation if any of the following apply to you:

    •Ingrown hairs and open bumps on the eyebrows or area of procedure. Injured/ Inflamed skin cannot be treated.

    •Eczema, Psoriasis, and Dermatitis (Constant flaking, itching, irritation, and shedding of skin is not healthy) Rosacea (Chronic acne like skin indicated by redness, skin bleeds easy and will not retain pigment well.)

    •Moles/ Raised areas on or around area of procedure. (Anything raised will not retain color.)

    •Hypertrophic Scarring or Keloids Deep wrinkles in eyebrow area. (Example: Microblading hair like strokes will not lay properly in the creases, giving the eyebrows an uneven look.)

    •Hair transplant for eyebrows. (Pigment may not take in the scar tissue where the plugs were placed.)

    •Fitzpatrick Skin type 1 (Redheads, translucent skin/light eyes- due to hypersensitivity and thinness this skin type bleeds very easily and does not take the pigment well.)

    •Retinol/Retin-A, Vitamin A users (Skin composition is altered- MUST DISCONTIUNE USE 30 DAYS PRIOR TO APPOINTMENT.)

    •Accutane (Must discontinue 6 Months prior to appointment.)

    •Tanned/Sunburnt skin, (Skin is not normal color and it damaged.)

    •Use of Latisse or any eyelash/eyebrow growth conditioner. (Hair follicles are hypersensitive and will bleed easily. Must discontinue 30 days prior to appointment.)

    •Have face/ body dysmorphic disorder. (Expectations cannot be met.)

    Health Contraindications:

    •Pregnancy

    •Nursing

    •Taking blood-thinners such as aspirin or similar medications

    •Glaucoma

    •Herpes Simplex

    •Allergy to makeup

    •Diabetes

    •Lupus

    •Hepatitis B/C

    •HIV/AIDS

    •Active Vitiligo

    •Blood Disorders: Sickle Cell, Hemophilia

    •Mental Disorder

    •Steroids (Must be off for 6 Months)

    •Chemotherapy

    Thyroid conditions can affect the way the pigment color heals, making them a less predictable. If you are unknown of any of these, please bring Medical Clearance from your Physician before the procedure.

    ACCEPTING MY POLICIES AND GOING WITH THE PROCEDURE INDICATES THAT YOU DO NOT HAVE ANY OF THE ABOVE.

    POSSIBLE RISKS, HAZARDS OR COMPLICATIONS:

    • Pain: There can be pain even after the topical anesthetic has been used. Anesthetics work better on some people than others.
    • Infection: Infection is very unusual. The areas treated must be kept clean and only freshly cleaned hands should touch the areas.
    • Uneven Pigmentation: This can result from poor healing, infection, bleeding or many other cases. 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 and swell more than others. Ice packs may help. Bruising and swelling typically disappears within 1-5 days. In most cases, people do not bruise or swell at all.
    • Anesthesia: Topical anesthetics are used to numb the area to be tattooed. Lidocaine, Prilocaine, Benzocaine, Tetracaine and Epinephrine in a cream or gel form are typically used. If you are allergic to any of these please inform me now.
    • MRI: Because pigments used in permanent cosmetic procedures contain inert oxides, a low-level magnet may be required if you need to be scanned by an MRI machine. You must inform your technician of any tattoos or permanent cosmetics you may have.
    • Fever Blisters: If you are prone to cold sores or fever blisters (Herpes simplex), there is a high probability that you will get them. It is advised that you call your doctor for a prescription antiviral to help prevent this from occurring.
    • Allergic Reaction: There is a very small possibility of an allergic reaction. You may take a 5–7-day patch test to determine this.
    • Anaphylaxis: A severe, potentially life-threatening allergic reaction. The reaction can occur within seconds or minutes of exposure to an allergen.

    The alternative to these possibilities is to use cosmetics and not undergo the permanent cosmetics procedure.

     

  • Please consent or decline patch test:*
  • Date*
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  • CREDIT CARD AUTHORIZATION

  • I give my consent for MilaV Aesthetics to make a payment using my card. I acknowledge that while this data is stored securely in a protected online client file, there is a small possibility of it being compromised. I agree to bear the responsibility if the file and credit card details are accessed without authorization. I also agree to reach out to MilaV Aesthetics for help or clarification if I have any doubts or inquiries about charges made to my account, or if a payment fails to be recorded. I acknowledge that I will not challenge any charges through my credit card provider unless I have first made an effort to resolve the issue directly with MilaV Aesthetics and those efforts have proven unsuccessful. I comprehend and consent to these terms. I comprehend the terms of this payment policy and consent to the aforementioned conditions.

  • Date*
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  • CANCELLATION, TARDY AND NO SHOWS POLICY

    PLEASE READ CAREFULLY
  • Cancellation Policy:
    Our goal to provide quality care in a timely manner. In order to do so, we have had to implement an appointment/cancellation policy.

    Appointments are in high demand, and your early cancellation will give another person the opportunity to have access to timely care. This policy enables us to better utilize available appointments for our clients.

    When making a booking, it is necessary to provide a valid credit or debit card to secure your appointment. To ensure the appointment is secured, a non-refundable booking fee must be paid. Rest assured that your card information will be kept confidential. Once your service is finished, you have the choice to pay using the card on file, zelle or with cash. If you opt for card payment, a 2.6% processing fee will be added. If you need to cancel or reschedule your appointment, please provide a minimum of a 3-day notice. A reminder will be sent 24 hours prior to your scheduled appointment time. However, cancelling after the 24-hour reminder will result in a cancellation fee equivalent to 50% of the remaining service cost.

    Tardy Policy:
    By arriving late, you may inconvenience other clients who arrive punctually. Clients are given a 10-minute grace period, but if you exceed this timeframe, you will receive notifications via text and email informing you that your appointment has been cancelled and will result in a cancellation fee equivalent to 50% of the remaining service cost. The deposit you made cannot be refunded and cannot be transferred for future use. If you wish to reschedule, you will need to submit a new non-refundable deposit when booking a new appointment. Each client is afforded only two opportunities to adhere to these policies. Failure to comply will result in being barred from booking any future appointments.

    NO SHOWS:
    Please note that in the event of a no-show, the paid booking deposit cannot be refunded and cannot be transferred to another appointment. Your failure to show up for your scheduled appointment prevents other clients from utilizing that time slot for their own services. However, in cases of no-shows, your credit card on file will be charged for the remaining 100% of the service fee, along with a 2.6% processing bank fee.

    I have read and understand the above Appointment Cancellation, Tardy, and NO SHOW Policy and agree to be bound by its terms. I agree to pay the cancellation fee in the event of a missed appointment. 

  • Date*
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  • PHOTO & VIDEO

    RELEASE FORM
  • I * hereby grant and authorize MILAV AESTHETICS LLC the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all pictures, videos and/or audio taken of me to be used in and/or for any lawful promotional materials including, but not limited to, newsletters, flyers, posters, brochures, advertisements, press kits, websites, social media sites and other print and digital communications, without payment or any other consideration.

    This authorization shall continue indefinitely and extends to all languages, media, formats and markets now known or later discovered.

    I waive any right to royalties or other compensation arising or related to the use of the photograph or recording.

    I understand and agree and agree that these materials shall become property of MILAV AESTHETICS LLC and will not be returned.

    I hereby hold harmless and release MILAV AESTHETICS LLC from all liability, petitions, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons may make while acting on my behalf of my estate.

    By signing below, i hereby acknowledge that I have completely read and fully understands the above release agreement.

  • Date*
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  • RELEASE OF LIABILITY

  • The individual clicking to accept this release (referred to as "I" or "me") desires to participate in certain spa and/or beauty services offered by MilaV Aesthetics (the "Business"). In consideration of being provided the requested spa and/or beauty services, I agree to all the terms and conditions set forth in this agreement (this "Release").

    1. I am aware and understand that participation may involve the risk of serious injury, disability, death, and/or property damage. I am also aware that there are no guaranteed benefits of the services requested, including therapeutic or alternative medicine services. I understand that the Business cannot guarantee that I will receive any sort of physical or psychological benefits from the services rendered. NOTWITHSTANDING THESE RISKS, I ACKNOWLEDGE THAT I AM VOLUNTARILY ACCESSING THE PREMISES AND REQUESTING SERVICES WITH KNOWLEDGE OF THE RISKS INVOLVED, AND I HEREBY AGREE TO ACCEPT AND ASSUME ALL RISKS OF ILLNESS, PERSONAL OR PSYCHOLOGICAL INJURY, PAIN, SUFFERING, TEMPORARY OR PERMANENT DISABILITY, DEATH, PROPERTY DAMAGE, AND/OR FINANCIAL LOSS ARISING THEREFROM, WHETHER CAUSED BY THE ORDINARY NEGLIGENCE OF THE BUSINESS OR OTHERWISE.

    2. I hereby expressly waive and release any and all claims, now known or hereafter known, against the Business and its successors, and assigns (collectively, "Releasees") on account of personal or psychological injury, illness, pain, suffering, temporary or permanent disability, death, property damage, or financial loss arising out of or attributable to my being on the premises and receiving certain spa and/or beauty services, whether arising out of the ordinary negligence of the Business or any Releasees or otherwise.

    3. This Release constitutes the sole and entire agreement of the Business and me with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. If any term or provision of this Release is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other term or provision of this Release or invalidate or render unenforceable such term or provision in any other jurisdiction. This Release is binding on and shall inure to the benefit of the Business and me and our respective successors and assigns. This Agreement shall be governed by the laws of the state Business maintains its primary location.

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  • PRE & POST OP CARE

    PLEASE READ!!
  • Small Details Make a BIG Difference
    What to do Before & After your Permanent Makeup Procedure

     

    -Do not pick/tweeze/wax/perform electrolysis one week before the procedure.
    -Do not tan two weeks prior or have sunburned face/skin.
    -Do not have any type of facial 2 weeks prior to treatment.
    -Do not work out the day of the procedure.
    -Do not have botox 3 weeks prior.
    -Do not take Fish Oil or Vitamin E one week prior (natural blood thinners)
    -Do not wax or tint your eyebrows 3 days before the procedure.

    In order to avoid excessive bleeding and poor colour deposit:

    Do not drink alcohol 24 - 48 hours before your tattoo
    Do not consume coffee or any caffeine before your procedure
    Do not take an aspirin or ibuprofen for pain relief (this thins the blood)

    Now that you know what NOT to do, it’s time to share my secret recipe for amazing PMU results! I love a good acronym so here’s one to help you out, just think of A - W - M which stands for Absorb, Wash, Moisturize! 

    The day of the treatment: Absorb

    Gently blot the area with a clean tissue to absorb excess lymph fluid. Do this every 5 minutes for the full day until oozing has stopped.  Removing this fluid prevents hardening of the lymph.

    Days 1-7: Wash

    Wash daily to remove bacteria and dead skin. (Don't worry...THIS DOES NOT REMOVE THE PIGMENT!)

    Gently wash your procedure area each morning and night with water and an antibacterial soap like Dial Soap, Cetaphil or Neutrogena. With a very light touch, use your fingertips to gently cleanse the affected area. Rub the area in a smooth motion for 10 seconds and rinse with water ensuring that all soap is rinsed away. To dry, gently pat with a clean tissue. DO NOT use any cleansing products containing acids (glycolic, lactic, or AHA), or any exfoliants.  

    Days 1-7: Moisturize

    Apply a rice grain amount of Aftercare ointment with a cotton swab and spread it across the treated area. Be sure not to over-apply as this will suffocate your skin and delay healing. The ointment should be barely noticeable on the skin. Never put the ointment on a wet or damp tattoo. 

    AWM should have you covered, but here are some extra tips to help with a smooth and easy recovery:

    Important Reminders

    -Use a fresh pillowcase
    -Let any scabbing or dry skin naturally exfoliate away. Picking can cause scarring or loss of colour.
    -No facials, botox, chemical treatments or microdermabrasion for 4 weeks
    -Avoid hot, sweaty exercise for one week
    -Avoid direct sun exposure or tanning for 4 weeks after the procedure. Wear a hat when outdoors.
    -Avoid heavy sweating and long hot showers for the first 10 days.
    -Avoid sleeping on your face for the first 10 days
    -Avoid swimming, lakes, hot tubs for the first 10 days
    -Avoid topical makeup including sunscreen on the area
    -DO NOT rub, pick or scratch the treated area.

    Remember, with the proper prep and aftercare routine you will have much better results with your microblading procedure. Don’t forget your new favourite acronym: AWM - Absorb, Wash, Moisturize!

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