CONSENT TO MICROBLADING / SEMI-PERMANENT MAKEUP PROCEDURE
Eudora Aesthetics & Microblading LLC
This consent form is intended to provide the information necessary for you, the undersigned client, to make an informed decision regarding undergoing a 3D Eyebrow Microblading and/or semi-permanent brow makeup procedure. Please read each section carefully. If you have any questions or concerns, do not hesitate to ask prior to signing.
1. PROCEDURE DISCLOSURE
I acknowledge and understand that Microblading and/or shading are forms of semi-permanent tattooing. These techniques involve the use of a manual or machine-operated needle or blade to insert pigment into the upper layers of the skin (epidermis). This is not a permanent tattoo.
2. USE OF TOPICAL ANESTHETICS
I understand that topical anesthetic creams may be applied prior to and during the procedure to reduce discomfort. In rare cases, allergic or sensitivity reactions to anesthetics such as Lidocaine, Prilocaine, Benzocaine, Tetracaine, and/or Epinephrine may occur. I confirm that I have disclosed all known allergies and medical conditions to the technician.
3. POTENTIAL RISKS AND COMPLICATIONS
I acknowledge and understand that, as with any cosmetic procedure, there are potential risks including, but not limited to:
Pain: Some discomfort may still be experienced despite the use of numbing agents. Individual pain tolerance varies.
Infection: Though rare, infection may occur if proper aftercare is not followed. I understand that I must follow the aftercare instructions provided and only touch the treated area with clean hands.
Uneven Pigmentation: This may result from a variety of factors including poor healing, bleeding, or infection. A follow-up session can be needed to correct any irregularities.
Asymmetry: While every effort will be made to achieve symmetry, natural facial features are often asymmetrical. Adjustments may be necessary at a follow-up appointment. When the session is finished, the brows often are swollen and red which can lead to the initial appearance of asymmetry. The artist will not make any adjustments until the swelling has subsided and the brows are 6 weeks healed.
Swelling/Bruising: Some individuals may experience temporary swelling or bruising, which typically subsides within 1–5 days.
Adverse Reaction to Anesthetics: Mild symptoms such as headaches or lethargy may occur following anesthetic application.
4. ALTERNATIVES
I understand that the alternative to this procedure is to continue using traditional cosmetic makeup, and that this procedure is completely elective.
5. LIMITATIONS AND EXPECTATIONS
I understand that while the results of Microblading are often effective, no guarantees can be made regarding the final outcome. Multiple factors such as smoking, excessive sweating, oily or sensitive skin, anemia, thyroid disorders, use of retinoids or exfoliants, and sun exposure may affect pigment retention or healing. Excessive bleeding may also result in poor pigment retention. Final healed results vary by individual.
6. CLIENT AGREEMENT ON DESIGN
I understand that I will have the opportunity to approve the final brow shape and pigment color before the procedure begins. By proceeding with the procedure, I confirm that I have approved the design and have had all of my questions answered to my satisfaction.
7. WAIVER AND RELEASE OF LIABILITY
By signing below, I voluntarily consent to receive the Microblading and/or shading procedure provided by Eudora Aesthetics & Microblading LLC. I release and hold harmless Eudora Aesthetics & Microblading LLC and all employees, contractors, agents, and affiliates from any and all liability, claims, damages, or legal actions arising out of or connected to this procedure, whether caused by negligence or otherwise.
I further understand that I am solely responsible for seeking medical attention if needed, and any such care will not be provided by or covered by Eudora Aesthetics & Microblading LLC.
Touch-Up Procedure Acknowledgment (6–12 Weeks Post Initial Session)
I acknowledge that I have been informed that a touch-up session is not included in the cost of the initial Microblading/Semi-Permanent Makeup procedure. However, a touch-up may be necessary to refine or adjust the shape, color, and symmetry, or to address any areas where pigment retention was suboptimal following the initial procedure.
It is understood that:
A touch-up session performed between 6 to 12 weeks following the initial procedure is available for a fee of $100.
A touch-up session performed after 12 weeks but before 16 weeks will incur an additional $100 fee, totaling $200.
Any touch-up session scheduled after 16 weeks from the initial procedure will be considered a 3-18+ month touch-up procedure and subject to the full rate of $325.
The need for a touch-up varies by individual, and while many clients achieve satisfactory results after one session, additional treatment may be required based on personal healing, skin type, and pigment retention.
Client Consent and Acknowledgment
I hereby certify that I have read this acknowledgment, or it has been read to me. I fully understand the nature of the touch-up policy, including the potential fees and timelines. I have had the opportunity to ask questions, all of which have been answered to my satisfaction. I understand the risks, alternatives, and limitations of this procedure and give my informed consent to proceed.