Client Intake form

Have you ever had a cosmetic tattoo or permanent makeup procedure before?NoYes If yes, when was your last procedure?

We are delighted to offer you our professional Permanent Makeup (PMU) services. Before proceeding with any PMU procedures, it is crucial that you fully understand the process, potential risks, and expected outcomes. This document serves as your informed consent form for PMU treatment at Beauty By Design, LLC.

Please carefully read the following information and kindly sign the consent form at the end to indicate your understanding and agreement.

Purpose and Nature of PMU:

Permanent Makeup is a cosmetic procedure that involves the application of pigments into the dermal layer of the skin. The purpose of PMU is to enhance and define specific areas of the face, such as eyebrows, eyeliner, and lip color. PMU provides a long-lasting, natural-looking enhancement that may reduce the need for daily makeup application.

Risks and Limitations:

A. Pigment Allergy or Sensitivity: There is a small risk of an allergic reaction or sensitivity to the pigments used in PMU. Although rare, it is crucial to inform the technician of any known allergies or sensitivities before the procedure.

B. Infection: As with any invasive procedure, there is a risk of infection. Our team follows strict sanitation and sterilization protocols to minimize this risk. However, individual healing and post-treatment care play a significant role in preventing infection.

C. Discoloration and Fading: Over time, the pigmented areas may fade or change color due to factors such as sun exposure, skin type, and individual healing response. The pigment may also spread or migrate slightly, resulting in a less precise appearance. Periodic touch-ups may be necessary to maintain the desired results.

D. Uneven Pigment Distribution: There is a possibility of slight unevenness in the distribution of pigment during the initial procedure. This may require adjustments or corrections during subsequent touch-up sessions.

E. Skin Conditions and Scar Tissue: Existing skin conditions or scar tissue in the treated area may affect the final results of PMU. These factors can alter pigment retention and may require additional procedures for satisfactory outcomes.

F. Unpredictable Healing: Every individual's healing process is unique, and there may be unexpected changes or outcomes that cannot be predicted or guaranteed. The final results of PMU may vary based on factors such as skin type, lifestyle, and individual healing capabilities.

G. Eye and Lip Sensitivity: The application of PMU around the eye or lip area may cause temporary sensitivity, discomfort, or swelling. This is a normal part of the healing process and typically resolves within a few days.

Pre-Treatment Consultation:

Before the PMU procedure, a thorough consultation will be conducted to assess your goals, medical history, and any contraindications. It is essential that you disclose all relevant information, including medications, previous cosmetic procedures, and known allergies. This information will help us ensure your safety and determine the most suitable treatment plan.

Treatment Procedure:

The PMU procedure will be performed by our trained and experienced technician, following industry best practices and safety guidelines. The process involves the use of sterile, disposable needles and the application of pigments to the desired area(s) of the face. Topical anesthetics may be used to minimize discomfort during the procedure.

Aftercare: Proper aftercare is crucial for optimal healing and long-lasting results. You will receive detailed aftercare instructions, which must be followed diligently. Failure to adhere to the instructions may result in complications or impact the final outcome of your PMU. It is important to avoid exposure to sunlight, excessive moisture, swimming pools, saunas, and strenuous activities during the healing period.

Touch-Ups:

Depending on individual healing factors, you may require a touch-up session after the initial PMU procedure to achieve the desired results. This touch-up is typically scheduled within 4–6 weeks after the initial treatment. Additional touch-ups may be necessary in the future to maintain the appearance of the PMU. Please note that touch-up sessions may involve additional costs, which will be discussed with you beforehand.

Costs and Payment: Please refer to the separate pricing and payment agreement for detailed information on costs, payment methods, and cancellation policies. Any questions regarding pricing or payment should be addressed before the procedure to ensure clarity and avoid any misunderstandings.

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

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

I understand and agree that these materials shall become the property of Beauty By Design, LLC and will not be returned.

And causes of action which I, my heirs, representatives, executors, administrators, or any I hereby hold harmless and release Beauty By Design, LLC from what other persons may make while acting on my behalf or behalf of my estate.

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

Our goal is 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.

At the time of booking your appointment you will be asked to pay a deposit that will be credited towards your treatment/s.

Time has been specifically reserved for your appointment, procedure, or treatment. If you need to cancel or reschedule your appointment, you must call at least 24 hours before your appointment and your deposit will either be refunded or pushed for a future appointment. However, providing less than 24 hours' notice will require you to pay a $100 cancellation fee.

If you arrive more than 20 minutes late for your appointment it is considered a no-show and you will be charged the cancellation fee.

I have read and fully understand the above Appointment Cancellation Policy and agree to be bound by its terms. I agree to pay the cancellation fee in the event of a missed appointment.

The new coronavirus is something I'm aware of. By the World Health Organization, COVID-19 has been deemed a global pandemic. And I am aware that COVID-19 is a highly contagious virus that is thought to spread through direct contact between people.

Please answer each of the following inquiries as honestly and competently as possible.

 

I hereby release and hold harmless liabilities related to COVID-19 exposure. EVEN IF ARISING FROM THE NEGLIGENCE, ACTS, OR OMISSIONS OF THE RELEASED PARTIES.

By signing this agreement. I voluntarily assume the risk that I may be exposed to or infected by COVID-19.