Permanent Make Up

 

CONSENT AND DISCLOSURE FORM FOR

PROCEDURE OF PERMANENT MAKE UP

REMOVAL

 

Client Details

I hereby consent to and authorise Magdalena Dafforne (DAFFORNE PMU) to perform the choosen by me Permanent Make up treatment.  

Although it is impossible to list every potential risk and complication, I have been informed of possible benefits, risks, and complications of this treatment. I also recognise there are no guaranteed results and that independent results are dependent upon age, skin condition, and lifestyle and that there is the possibility I may require further treatments of the treated areas to obtain the expected results at an additional cost. 

I have read and understand the post-treatment home care instructions. I understand how important it is to follow all instructions given to me for post-treatment care. In the event that I may have additional questions or concerns regarding my treatment or suggested home product/post-treatment care, I will consult the practitioner immediately. 

I have also, 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 ingesting or using topically. 

 
I have read and fully understand this agreement and all information detailed above. I understand the treatment and accept the risks. All my questions have been answered to my satisfaction and I consent to the terms of this agreement. I do not hold the technician (nor the establishment), whose signature appears below, responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today. I also release Magdalena Dafforne of any liability that may arise from this procedure.

I understand, have read and completed the questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the skin from treatments received. I am aware that it is my responsibility to inform the practitioner of my current medical or health conditions and to update this history. I understand that the services offered are not a substitute for medical care and any information provided by the practitioner is for educational purposes only and not diagnostically prescriptive in nature. I understand that the information herein is to aid the practitioner in giving better service and is completely confidential. The treatments I receive here are voluntary and I release Magdalena Dafforne and ‘DAFFORNE House of Beauty’ (DAFFORNE PMU) from any liability and assume full responsibility thereof.

I consent to the reproduction and use of my photo(s) & video(s), with the consent of the producing agent(s), DAFFORNE PMU. ONLY. Consent shall involve the use of my photos & videos for websites, social media and advertising thereof. 

This consent, as stated above, shall be a continuing consent for all procedures, past, present & future. Written notice must receive from the client asking to discontinue use (60 days written notice required).

I give Magdalena Dafforne DAFFORNE PMU permission to use my photo/s & video/s for any legal use, including but not limited to: publicity, copyright use, illustration, marketing, advertising purposes & web content as marked below.

AGE RESTRICTIONS:

Permanent Make Up is a group of treatments we offer to anyone of sound mind, able to make independent decisions and of an age 18+.

Due to our insurance policy we do not approve Parent's Consents to treatments for underaged children.

Bookings made by underaged clients will be canceled/or treatment refused, and charged 50% of treatment value where applies.

 
CANCELLATIONS & DEPOSITS:

Your DEPOSIT secures ONE booked slot and is charged per each booked treatment, and is non refundable under any circumstances.

 
RESCHEDULING:

We allow you to reschedule ONLY ONCE (minimum 72 hours prior to appointment date) without loosing the deposit, deposit will be lost thereafter.

 
New deposit will be added to the final bill for each following re-schedule of the booking (no 72h window applies), this includes failing to attend for a patch test which won't allow us to go ahead with the procedure.

 
In case you reschedule your appointment 5 times, your booking will be cancelled and charged outstanding deposits balance (value of 3x deposit), future new booking will have to be paid for upfront & in full within 24h to secure the slot.

 
In case of a price change, we will honour 'old' rate only for 1st reschedule, new rate will apply thereafter.

 
CANCELLATIONS & NO-SHOWS:

 
All cancellations and no-shows result in loss of deposits, additionally, late cancellations (with shorter notice than 7 days) and no-shows will be charged 50% of remaining balance of the treatment plus outstanding deposits (if previously re-scheduled numerous times). 

New deposit will be charged to book new slot & only one deposit will be deducted from your final treatment price.

 
In case of failing to attend to your appointment 3 times for any reason, future new booking will have to be paid for upfront & in full within 24h to secure the slot.

Accounts which we are not able to charge due to insufficient funds or errors will be put on hold until outstanding fees are cleared, if unpaid within 3 months we’ll recover outstanding balances via debt collectors agency or small court.

 
PATCH TEST:

 
Patch test must be performed minimum of 24h prior to treatment.

We do not honour patch test from other salons. We strongly advise repeating patch test before each procedure. Due to our insurance policy, patch test must be performed regardless of having previous body tattoos or PMU.

 
RIGHT TO REFUSE:

 
DAFFORNE PMU reserves the right to refuse treatment to any client without giving a reason or explanation (without being unreasonable)

Examples:

In case of disagreement in managing client's expectations.

Not being able to agree on shape, colour etc.

If client is asking to perform treatment which is not in line with Dafforne PMU conscious, knowledge, training, technique or business model - my work is my advertisement, please understand I will not perform anything I am not going to be proud to call mine.

We will not tolerate rudeness, bullying, aggression or violence towards ourselves or any member of staff, you will be asked to leave.

No refund of deposit will be offered.

ATTENDANCE OF MINORS & THIRD PARTIES:

 
Please DO NOT bring children or other parties with you to your appointment.

Our insurance policy doesn't cover anyone on premises who isn't a client therefore third parties (partners, friends, kids etc.) WILL NOT be allowed to stay at the premises during your treatment, your appointment will be cancelled and result in charge of 50% treatment value. It is also to ensure that You and all other clients having treatments get relaxing experience in peaceful and quiet environment.

 
BEFORE YOUR APPOINTMENT:

 
Please read carefully how to prepare your skin before treatment to ensure best healed results - that's 25% of the outcome!

Please bring your filled in forms when you attend your patch test appointment 1-2 days prior to treatment.

STRICTLY:

Drink 3L of Water daily for 5 days prior - hydrated skin heals quicker and retains more pigment.

NO ALCOHOL (48h prior),

NO CAFFEINE & IBUPROFEN (on the day),

NO RETINOL & AHA skincare (during 30 days leading to the procedure)

 
Refer to "Pre & AfterCare" on the website for more tips.

I understand that by agreeing to all of the terms above I enter the contract with DAFFORNE PMU and any unpaid charges and fees may be recovered via small court claims or debt collectors agencies: