Microblading Consent & Appointment Form

Consent & Appointment

Please review and complete this consent and appointment form carefully. Your cooperation is appreciated.
$10 deposit required to secure appointment

💋Remaining balance must be paid in EXCAT cash! NO EXTRA GUEST!💋
Client*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
By checking the following boxes, confirm your informed consent to the 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 your consent to receive 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 certify that the information provided is accurate and complete. I have read, understood, and agreed to all terms and conditions. I release the beauty studio and associated parties from any claims or liabilities.
Do you have any health issues? Please list below:*
Client Signature*

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Appointment*
Appointment type:*
Music option [select your favorite music station we will play music during your appointment]*
Please verify that you are human*

Consent & Appointment

$10 deposit required to secure appointment