Tattoo/Microblading Consent Form

Tattoo/Microblading Consent Form

This is a legal document. Please read carefully
Client Information
Full Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Phone Number

Area CodePhone Number
Phone Number*

Area code +44Phone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pre-Procedure Questionnaire
Are you under the influence of drugs or alcohol?

YesNo
FEMALE ONLY: Pregnancy or Nursing?

YesNo
Do you have a communicable disease?

YesNo
Skin conditions (e.g. Rashes, eczema, infection, psoriasis, freckles, etc.)
If yes, please identify the condition.
Are you currently taking any medication?
Medical History (e.g. DIabetes, Cardiovascular Disease, Epilepsy, Blood-related disease etc.)
If yes, please identify the condition.
Any known allergies ?
Have you previously had semi permanent make up done ? And when if yes also what was it machine or manual
Patch test required do you agree to done for a test before ? Allergic reactions can still occur a negative patch test result does not guarantee you will not have a reaction . Reactions may be immediately or delayed .
Microblading can heal patchy and different colour from what has been used , this is out of our control and we cannot guarantee any results from microblading or how long they will last are you happy to accept this risk ? *
Top ups may be required we cannot say if you will need extra sessions top ups . Top ups under 12month are £100 per session deposit required on booking. Are you happy to proceed knowing you may need extra sessions to get your desired result from microblading ?
Microblading is a way of cosmetic tattooing, intended to be semipermanent lasting average 6-18 months. On a rare occasion, the pigment may migrate under the skin. Please understand this is a risk which can happen although Rare . Do you accept this risk *
Above is showing how we make sure your eyebrows are drawn on perfectly to suit your face . We use this guide as microblading is not a 1 shape fits all . Every person brows are tailored to suit there face shape . When we draw on your brows prepare for them to not look like they will when complete . When pre drawing we use a combination of of black and white pencils to mark exactly we're is needed to tattoo
Above is some examples of different microblading techniques could you please select which you prefer (this is not 100% how they will look everyone eyebrows are different )

1234None!
As same as above this is a pre drawn selection of styles Available please select which you like ?

1234None!
This is showing more clearly the difference between different methods please choose

1234
Acknowledgment and Waiver
Please tick bellow to confirm you have read and fully understand the following*

I understand that this procedure is a permanent change to my skin and body.
*

I allow my tattoo to be photographed and be used for Tattoo Shop portfolio showcased.
*

I acknowledge that the Tattoo Shop does not offer refund.
*

I agree that the studio does not have a way of identifying if I am allergic to the elements or ingredients that will be used for my tattoo.
*

Sometimes bleeding cannot be made undercontrol and you will still be charged for your session . Caffeine and alcohol for 48hr prior is an absolute NO ! As this will effect bleeding
If you bleed a lot during treatment this can have an effect on healing this is something we cannot control
*

I understand that I need to take care of the microblading by following the instructions given to me by Charmaine also you will revive a small business card with instruction on to remind you
*

NO GYM / WORKING OUT FOR 7 days ? You agree not to exerciseAftercare is vital and it is YOUR Responsibility to look after your brows to achieve the best healing
*

most customers need a touch up to assure that brows are perfectly even and desired effect was achieved. Some people may need several sessions to perfect the perfect brows each extra session will be extra charge
*

I understand that I might get an infection if I don't follow the instructions given to me in regards of taking good care of my tattoo.
*

I indemnify and hold harmless the Tattoo Shop against any claims, expenses, damages, and liabilities.
*

I confirm that the information I provided in this document is accurate and true.
Signed Date

MonthDayYear
Date
Client Signature
Should be Empty:

Tattoo/Microblading Consent Form

Client Information

Pre-Procedure Questionnaire

Acknowledgment and Waiver