Permanent Makeup Consent Form

Name

First NameLast Name

Gender

Date of Birth

Date

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email Address

Please enter a valid email.

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact

Full NamePhone Number

List all medications you are currently taking.

If none, please type "N/A"

List any known allergies.

If none, please type "N/A"

Within the last year, have you undergone any surgery or plastic surgery?

If none, please type "N/A"

Have you had permanent makeup done before??

If none, please type "N/A"

Permanent Makeup Disclosure & Release

Please read & sign to agree to the following:

The fee paid today is for ONE session. I understand that if a follow up session is needed, that will be an additional charge. The follow up session must be within 12 weeks of the first session.
Though the procedure is called permanent makeup, it may or may not be permanent.
Result is not guaranteed. There may be fading or discoloration.
I have seen & agree to the pre draw shape my artist has created. I understand this is a guideline and it may vary once the procedure is done. Some instances we don't do a predraw.
There may be risks & hazards related to recieving this procedure.
There may be discomfort or pain duriing the procedure.
There is a possibility of bleeding, redness, swelling or allergic reactions to pigment.
Final result cannot be determined until 4 to 8 or more weeks after initial session.
I have recieved, read and understand after care instructions. I will follow instructions as given.
I am NOT pregnant and/or breastfeeding.
I am NOT under the influence of alcohol or drugs.
I am over the age of 18.
This procedure has been explained to me.
I fully understand the procedure and give permission to my artist to perform the procedure & all steps involved.
I have refused the patch test.
I have been informed of the nature, risks and possible complicatons and consequences. I understand permanent skin pigmentation procedure carries with it known and unknown complications and consequenses associated with this type of cosmetic procedure, including but not limited to: infection, allergic reaction, scarring, inconsistent color and spreading, fanning or fading of pigments. I understand the actual color of pigment may be modified slightly due to the tone and color of my skin. I fully understand this is a tattoo process, and therefore not exact exact science, but an art. I request the microblading procedure and accept the performance of the procedure as well as possible complications and consequences. I understand that while this is sometimes referred to as a semi permanent in nature due to each individual's reaction to pigment, the length of time pigment is present cannot be guaranteed. In some cases pigment will be permanent.
I understand that if I have any skin treatments, laser, hair removal, plastic surgery, or other skin altering procedures, it may result in adverse damages to my permanent cosmetics. I acknowledge some of these potential adverse changes may not be correctable.
I have received pre-and post procedure instructions and I will strictly adhere to such instructions. I understand that my failure to do so may jeopardize my chances for a successful procedure. If I am on any medication's for depression or other mood altering prescriptions, I will advise my technician.
I understand that the taking of before and after photographs of the said procedure are a condition of such procedure. I certify I have read this form in its entireity, and have been explained to my understanding this consent and the procedure process. I accept full responsibility for my decision to have this cosmetic tattoo work done.
I agree to the use of photos taken for social media/advertisng & educational and any other purposes.
I have truthfully filled out consent forms & have informed my artist of all medications taken.
I understand there are NO REFUNDS. The nature of this procedure does not allow for guarantee of result.
I release RB Beauty Bar and all representatives/subsidiaries of all claims of injury, seen or unseen as a result of this procedure.

Signature

Todays Date

Date

Microblading Instructions

Aftercare

First 24 hours

Gently blot brows with a clean tissue. This helps prevent buildup and scabbing. Avoid applying creams, water, or ointments during this time unless instructed otherwise.

Days 1 - 7

Gently cleanse brows once a day using lukewarm water and a mild fragrance-free cleanser. Use your fingers or a clean cotton pad - never scrub. Pat area dry and apply thin layer of ointment if advised.

Days 7 - 14

Pigment may appear lighter or patchy as your skin heals, this is normal. Continue with washing both day and night until healed. If you have oily skin, use aftercare only after washing. If you have normal to dry skin, apply aftercare throughout the day as needed, when brows feel dry. Do not overuse aftercare.

DO NOT get brows wet other than washing. Be careful when showering
DO NOT take steamy showers.
DO NOT go swimming
DO NOT expose your brows to the sun. Wear a hat if you will be outside for a prolonged period of time.
DO NOT sweat for 10 days. This means no working out
DO NOT apply makeup to the brow area. Other makeup is fine, but avoid touching the brows.
DO NOT apply anything but the aftercare product provided to your brows.
DO NOT get facials and/or peels for 4-6 weeks.
DO NOT get botox for 2 weeks.
DO NOT pick the flaking color, this can remove it completely, let it release on its own.

Brows are fully healed at 4 to 6 weeks. During this time, you may notice changes in your brows that can be alarming. They will get darker, shed lightly and then seem very light. The color is hiding underneath a layer of opaque, healing skin. This will go away within 2 weeks. You may feel they appear uneven at times due to this. At 4 weeks, if you need they need it, you can schedule a touch up for $125. The touch up can be performed at 6 weeks & up to 12 weeks.

Thank you for following our aftercare instructions and we hope you enjoy your new brows!

Lip Blushing Instructions

Precare

1 - 3 days before procedure

Exfoliate lips with a gentle lip scrub, soft toothbrush or damp washcloth 1 to 3 days before procedure to give your lips time to recover from any irritation. Doing this removes dead skin and enhances pigment retention. This ensures a smooth even surface for application and allows color to evenly deposit.

Aftercare

First 24 - 48 hours

Gently blot brows with a clean tissue. This helps prevent buildup and scabbing. Avoid applying creams, water, or ointments during this time unless instructed otherwise.

Days 1 - 7

Expect some swelling, tenderness, scabbing or flaking. Keeps lips clean and moisturized with gentle unscented products. Refrain from using makeup on or near the area, it may cause irritation.

Days 7 - 14

Pigment may appear lighter or patchy as your skin heals, this is normal. Continue using gentle lip products to keep the area moisturized.

DO NOT take steamy showers
DO NOT go swimming
DO NOT expose your lips to the sun
DO NOT sweat for 10 days. This means no working out
DO NOT apply makeup to the lip area. Other makeup is fine, but avoid touching the lips.
DO NOT apply anything but the aftercare product provided to your lips.
DO NOT get facials and/or peels for 4-6 weeks.
DO NOT get botox/filler for 2 weeks.
DO NOT pick the flaking color, this can remove it completely, let it release on its own.

For long term care, use lip balm with SPF. Avoid laser treatments or chemical peels near the lips. A touch up appointment is usually recommended 6 to 8 weeks after initial session to perfect the shape & color!

Thank you for following our aftercare instructions and we hope you enjoy your new enhanced lips!

Cold sores & Lip blushing - What you need to know

If you are prone to cold sores (herpes simplex virus), getting a lip blushing procedure can trigger an outbreak because the trauma to the lips activates the dormant virus,

Consult your doctor, you may be prescribed an antiviral medication. Start antivural 2 - 3 days before appointment and continue fror several days after.

A cold sore can impact healing affect pigment retention. If your actively experiencing a cold sore, you must reschedule your appointment.

Thank you for your understanding!

Cancelation Policy Form

We are committed to providing all of our clients with exceptional care in a timely manner. For this reason, we have instituted a 24 hour cancellation policy for all appointments.

We understand that sometimes life gets in the way and appointments need to be rescheduled or canceled. However, we kindly ask that you provide at least 24 hours' notice if you need to cancel or reschedule your appointment. This allows us to offer the time slot to another client who may be waiting for an appointment.

If you need to cancel or reschedule within 24 hours of your appointment, a fee of 50% of the service cost will be charged. If you do not show up for your appointment and do not provide any notice, the full cost of the service will be charged.

If you are late we reserve the right to cut your service, you will be charged for the service you booked not the cut service. If you are more than 15 minutes late and we do not have enough time to perform the service due to timing, you will be charged in full.

We appreciate your understanding and cooperation in following our cancellation policy. Our goal is to provide the best possible service to all of our clients, and this policy helps us achieve that goal by ensuring that our estheticians' time is used efficiently and effectively.

I have read this policy and understand that I need to provide at least 24 hours notice when rescheduling or cancelling an appointment. If I fail to contact the office at least 24 hours in advance, I will be charged the appropriate cancellation fee.

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Photo & Video Release Form

I hereby grant permission to RB Beauty Bar and its employees to take photographs or videos of me, my likeness, and my overall appearance during my visit/appointment.

I understand that the photographs and videos may be used for promotional and marketing purposes, including but not limited to social media, website, print materials, and other forms of marketing. I understand that RB Beauty Bar has the right to edit and use these photographs and videos as they see fit.

I also understand that I will not receive any form of compensation or financial renumeration from the use of these photographs or videos.

I also understand that once the photographs or videos are used, RB Beauty Bar has no control over the use of the images by third parties, who may also use the images for their own purposes.

I release and discharge RB Beauty Bar, its owners and employees from any and all claims, demands, or causes of action that I may have against them arising out of or in connection with the use of the photographs or videos.

I hereby acknowledge that I have read and fully understand the terms of this release and that I have had the opportunity to ask any questions that I may have before signing.

By signing this release, I certify that I am at least 18 years of age. If under 18 years of age, a parent or legal guardian must sign this release.

By signing this form I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for educational purposes.

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