Permanent Makeup Consent Form
Legal Name
*
First Name
Last Name
Preferred Name
First Name
Last Name
Pronouns
Please Select
He/Him/His
She/Her/Hers
They/Them/Theirs
I prefer not to disclose
Date of Birth
*
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Month
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Day
Year
Date
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about us?
Please check all that apply:
*
I am 18 years of age or older
I am not currently pregnant or nursing
I am not under the influence of recreational drugs or alcohol
I do not have a history of hemophilia, bleeding disorders or are on any medication that may increase bleeding
I am not undergoing chemotherapy, nor have I gone through chemotherapy in the past 12 months
I do not have diabetes
I am not prone to keloid scarring
I do not currently have any type of infection and/or rash anywhere on my body
I do not have sensitivities to dyes, pigments or topical anesthetics (example: Lidocane)
I consent to have Megan Giesbrecht perform this permanent makeup procedure
I acknowledge that:
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I may have an allergic reaction to the pigments, dyes or topical anesthetics used during my procedure and accept the risk that such reaction is possible.
Infection is always possible as a result of the procedure, particularly in the event that proper aftercare is not followed.
I realize that variations in colour may exist between the colour selected and how it will ultimately look after my brows have healed.
Following the procedure my brows will darken for the first six (6) days and will lighten thereafter.
The final result will often not be obtained without returning for at least one (1) touchup appointment. These appointments are important to reshape or augment areas within the brow. This is done no earlier than four (4) weeks after your last appointment.
The final appearance of the brow will be achieved 6-8 weeks after the final visit.
Microblading will result in a semi permanent change to my appearance (for approimately but not limited to 8 months - 2 years) and that no representation has been made to me as to the ability to later change or remove the results.
Skin treatments such as but not limited to laser, plastic surgery or any other skin altering procedures may result in adverse changes to the procedure area.
Frank + Olive does not offer refunds for services performed.
Photo Release
*
For the purpose of documentation, I consent to the taking of before and after photos. Please note, these will NOT be used for marketing of any kind. Your artist requires you to consent to photographs for her professional and confidential customer files.
I consent to the use of my photos for the purpose of marketing. My pictures may appear in print or online.
Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Drivers license #
Signature
*
Please upload a clear image of a valid government-issued photo ID. This helps us verify your identity and ensures that we comply with legal and safety standards.
*
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