Microblading Consent & Appointment Form

Client*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

By checking the following boxes, confirm that you willingly consent to the following terms and conditions:*

I have been informed of the nature, risks, and possible complications and consequences of permanent skin pigmentation.I understand the permanent skin pigmentation procedure carries with it known and unknown complications and consequences associated with this type of cosmetic procedure, including but not limited to: infection, scarring, inconsistent color, and spreading, fanning or fading of pigments.Corneal abrasions are a rareside effect, especially if I rub or scratch my eyes or apply contacts too soon after any eyeliner procedure.I understand the actual color of the pigment may be modified slightly, due to the tone and color of my skin.I have read and understand the post-treatment home care instructions and understand how important it is to follow all instructions given to me for post-treatment care.

By checking the following boxes, confirm that you willingly consent to having the treatment during the COVID-19 pandemic:*

I am aware of the risks of having hair services during the pandemic.I understand that physical distancing of 6 feet may not be possible while in the salon receiving services.I will follow the rules in order to minimize the spread of viruses. I understand that I must sanitize my hands before entering the salon and I must wear a mask that covers my mouth and nose while in common areas.I confirm that I have not travelled domestically or internationally via public transportation within 14 days.I do not have any of the following COVID-19 symptoms: cough, shortness of breath, high fever, muscle pain, body ache, nausea, loss of taste, loss of smell.I have not contacted with anyone that have or may have COVID-19 symptoms or get infected within past 14 days.

I verify that the information I have provided on this form is truthful and accurate. I have read, understand, and checked all the terms and conditions. I release the beauty studio, stylists, officials, workers, stakeholders, members, and all of the parties related to the beauty studio from any and all of the claims and demands including damages, diseases, and or injuries.

Do you have any health issues? Please list below:*

Client Signature*

Appointment*

Appointment type:*

Music option [select your favorite music station we will play music during your appointment]*

Please verify that you are human*

Rate service *

Consent & Appointment

$10 deposit required to secure appointment