Microblading Consent Form

Contact in case of Emergency
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PHOTOGRAPHY RELEASE CONSENT:

We would like your permission to use these photos for advertising. For example, in portfolios, social media such as Facebook, Instagram, online and in print ads, etc. Your consent is necessary regarding this.

In addition, please indicate if you wish to have a patch test or not.

I confirm that I have read and understood thoroughly the aforementioned agreement.

Date: _____________________________________
I give my consent to tag me in social media

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Consent

I certify that I am over the age of 18 and not under the influence of drugs or alcohol, and I consent to receiving the microblading procedure. I have been informed, and it was explained to me the general nature of cosmetic tattooing as well as the specific procedure to be performed.

I have been informed of the possible risks and consequences of microblading, and I understand that there might be complications and consequences associated with this procedure, such as: infection, scarring, or inconsistent color. I understand that this cosmetic procedure may likely not be fully permanent and might result in fading in time. I have likewise received and will strictly adhere to procedural instructions given to me. Any adverse effects due to my failure to adhere to the instructions shall solely be my responsibility.

I acknowledge that some changes might not be corrected in case I undergo other laser hair removal, plastic surgery, or other procedures.

I understand that photographs taken for comparison of the before and after procedure are part of the said procedure.

I accept full responsibility for the decision to have this microblading procedure done. I do not hold Beverly Riley or Glam Haven, LLC liable. In addition, I understand The Sweetheart Salon is not affiliated and do not hold The Sweetheart Salon liable.

The cost for touch-up’s after this first procedure are not included.

Thank you and have a great day!
I have been advised to do a patch test to identify any allergic reaction to any medicine or anesthetics. Should I waive for the test, I release the technician from liability if I develop an allergic reaction to any of the procedures.

Yes, I want a patch testNo, I do not want a patch test
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Should be Empty:

	Yes	No
Currently Pregnant or breastfeeding
Had undergone Botox treatment
Has or any family history of Diabetes
Has Hepatitis A B C D
Had Forehead/Brow Lift
Has a Heart Condition
Had a Brow Lash Tinting
Has Autoimmune disorder
Have Oily Skin
Has, had, or any family history of having Cancer
Do you bleed excessively
Taking or have taken acne treatments in the past 3 months
Difficulty with numbing creams or anesthesia
Taking blood thinners such as: Aspirin, Ibuprofen, Alcohol, Coumadin etc
Any prior cosmetic procedure
Allergies to metals,medications, food, latex, lidocaine etc,
Any diseases other than listed here
Do you use facial care treatments
Did you have alcoholic drinks in the last 24 hours
Have you had any lip fillers
Do you get cold sores? If so, be aware to take your prescribed meds a wk before
Do you take Retin A products
Any skin issues? Hyperpigmentation, or other
Have you been positive for Covid 19 in the past 14 days
Do you have fever, chills, cough or other flu like symptoms
Will you want to have a patch test today, if no, be aware of risks and that you acept it
I have been consulted on pre and after care

Permanent Make Up Consent Form