Microblading and Shading Consent Form Logo
  • Microblading and Shading Consent Form

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  • **Please read and initial each statement:**

  • 1. **Purpose and Nature of Procedure:**

    • I understand that microblading and shading involve implanting pigment into the skin to create semi-permanent eyebrow makeup.
    • I am aware that the procedure can enhance the appearance of my eyebrows.


    Initials:      

    2. **Possible Risks and Complications:**

    • I acknowledge that there are risks associated with the procedure, including infection, allergic reactions, and skin irritation.
    • I understand that pigment may fade, change color, or spread over time, and touch-ups may be necessary.


    Initials:    

    3. **Pre-Procedure Requirements:**

    • I have disclosed any medical conditions, medications, or allergies to the technician.
    • I have followed all pre-procedure instructions provided by the technician.


    Initials:      

    4. **Post-Procedure Care:**

    • I understand the importance of following post-procedure care instructions to ensure proper healing and pigment retention.
    • I acknowledge that failure to follow these instructions may affect the results and longevity of the procedure.


    Initials:      

    5. **Results and Maintenance:**

    • I understand that the results of microblading and shading vary from person to person and are not guaranteed.
    • I am aware that touch-ups may be needed to maintain the desired look.


    Initials:      

    6. **Photography Consent:**

    • I consent to the taking of photographs before, during, and after the procedure for documentation and marketing purposes.

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    7. **Liability Waiver:**

    • I release the technician and the establishment from any liability related to the procedure and any potential adverse reactions or outcomes.

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    8. **Acknowledgment and Agreement:**

    • I have read and fully understand the information provided in this consent form.
    • I have had the opportunity to ask questions and have received satisfactory answers.
    • I voluntarily consent to undergo the microblading and shading procedure.


    Initials:    


    Signature:      Date:   Pick a Date  

    Name:         

  •  **Medical History Questionnaire:**


    1. Do you have any allergies?             
    If yes, please list:    

    2. Are you currently taking any medications?           
    If yes, please list:    

    3. Do you have any medical conditions that may affect the procedure? 
            If yes, please explain:      

    4. Have you had any previous microblading or shading procedures? 
       . If yes, when was the last procedure?          

    **Pre-Procedure Instructions:**

    • Avoid caffeine, alcohol, and blood-thinning medications for 24 hours before the procedure.
    • Do not apply any skincare products on the eyebrow area before the procedure.


    If you have any concerns or questions, please contact us before your appointment.

    Signature:      Date:   Pick a Date   

    Name:         

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