• Makeup Tattoo Consent Form

    This is a legal document. Please read carefully

  • Client Information

  • Date of Birth*
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  • Pre-Procedure Questionnaire

  • Have you received chemotherapy or radiation in the past year?*
  • Are you currently pregnant or breastfeeding?
  • Have you ever had allergic reaction to any of the following *
  • Have you ever had a cold sore?*
  • Are you currently taking medication that thins the blood?*
  • Are you currently under the care of a physicians?*
  • Do you take antibiotics when going to the dentist/ before surgical procedures?*
  • Have you ever had one of the following?
  • Do you scar easily?*
  • Do you bruise/ bleed easily?*

  • Each client’s brows are carefully designed to complement their unique face shape and bone structure. Before the procedure begins, a pre-draw is completed using a combination of black and white cosmetic pencils to outline the desired brow shape and map areas for tattooing.

     Please note: The appearance of the brows during the pre-draw phase may not reflect the final result. This stage is intended as a guideline to ensure accurate placement, symmetry, and overall design prior to beginning the permanent procedure.

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  • This is showing more clearly the difference between different methods please choose

  • Please read the following statements carefully. Microblading/ Ombre Shading is a way of cosmetic tattooing, intended to be semi- permanent lasting average 12-18 months. On a rare occasion, the pigment may migrate under the skin. Procedure of Microblading/ Ombre Shading may be uncomfortable. Although extremely rare, there might be an immediate or delayed allergic reaction to pigment. A negative patch test result does not guarantee that you will not develop an allergic reaction after the full procedure. Allergic reactions to anesthetic can occur. Permanent cosmetics cannot be performed if you are pregnant or nursing, or anyone under the age of 18. Infections can occur if aftercare instructions are not followed correctly. You may experience swelling, redness, or minor bleeding following the procedure. These symptoms are normal and typically subside within a few days. If you undergo an MRI scan within 3 months after your microblading procedure, please inform your doctor or MRI technician beforehand. In rare cases, scarring may occur depending on your skin type, aftercare, or if you have a history of keloid scarring.

    I have received after care information and I’m fully aware of the aftercare procedures. I fully understand the information provided above & consent that all information provided by me is correct and truthful.

    • Microblading/ Ombre shading procedure normally requires multiple treatment sessions. For best results, clients will be required to return for at least one re-touch appointment. (Re-touch appointment is NOT included in the initial price) It will take place 6-8 weeks on the initial procedure. Those with oily skin may require an additional touch up. Please be aware that color intensity will be significantly Darker and sharper immediately and a few days with the initial procedure, but the color will reduce by 30-50%

    • Although numbing cream is used during the procedure, sensitivity or discomfort may still be felt. Skin may be red and/or swollen after the procedure

    • Please no make up on the day of your procedure

    • Please DO NOT drink alcohol 24 hours prior to the treatment

    • If possible try to avoid the following herbs and spices prior to your appointment: Black pepper, Cardamom, any member of the Zingiberaceae (Ginger) family, Cayenne, Cinnamon, Garlic, Horseradish, Mustard.

    • Please DO NOT shape or wax your brows 7 days before the procedure. Your technician will shape your brows.

     

  • DURING THE PROCEDURE 
    • No electrolysis for at least 5 days before the procedure

    • Botox, AHA products and retinoids should be avoided for 2 weeks prior to the procedure

    • Exfoliating treatments such as microdermabrasion should not be performed within 2 week prior to the procedure.

    • Chemical and laser peels should be avoided no less than 6 weeks.

    • Patients prone to cold sores/fever blisters should take an anti-viral prior to treatment

    • Hormone therapies can affect pigmentation and/or cause sensitivity

  • Topical Anesthetic Advice
    • Allergic reaction can occur from any anesthetics used during the procedure. If you do suffer from an allergic reaction, you should contact your doctor immediately. Allergic reaction response may show through redness, swelling, rash, blistering, dryness or any other symptoms associated with an allergic reaction.

    • Numbness – We cannot accept responsibility if the area to be treated does not respond to the numbing cream. Each individual is different according to skin type. Some clients report the area to be completely numb, while others may experience some discomfort.

    • Procedure – For Microblading procedure, a numbing cream/gel is used. The products are formulated to be perfectly safe and can be purchased over the counter from any pharmacy/ chemist. The anesthetic is placed over the treatment area for 20-30 minutes then carefully removed prior to treatment.

    • As a result of the treatment, combined with the use of the anesthetic, you can expect to experience some redness/swelling that can last 1-4 days. You should always follow your post procedure advice and after care for the best results.

     

    Contraindications for Microblading

    • Pregnancy/Nursing

    • Liver disease – high risk of infection

    • Compromised skin near brow area

    • Chemotherapy/Radiation

    • The following medical conditions require a note from your doctor giving consent:

    • Diabetes Type 1 and 2

    • High blood pressure

    • Auto-immune disease, Thyroid / Graves’ disease

    • Any other medical


    Condition that causes slow healing or a high risk of infection.

    I have read and full understood the above information provided and any risks involved with the use of topical anesthetic and I therefore consent to the use of the anesthetic for the Microblading procedure. I agree to follow pre- and post-procedure advice closely.

  • INFORMED CONSENT

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    I, [First Name] [Last Name], confirm that I am over the age of 18. I am not under the influence of drugs or alcohol, and I am not pregnant or nursing. I willingly consent to receive the specified semi-permanent pigmentation procedure.

    The general nature of cosmetic micro-pigmentation, as well as the specific procedure to be performed, has been thoroughly explained to me. I understand the process and give my full consent to proceed.

  • I, First Name Last Name, give Iconik Beauty Studio permission to perform my Microblading procedure.

  • DISCLOSURE & RELEASE FORM

    I understand the following completely: (initial each statement)

  • Photo Waiver Release Form

    [Check this box if you grant permission for photographs or videos to be taken during the procedure for promotional or educational purposes.]

  • By signing below, I acknowledge that I have read and understand the terms of this photo waiver consent form and voluntarily agree to its contents.

  • POST PROCEDURE AFTER CARE 


  • • Upon completion of the procedure there might be swelling and redness of the skin, which will subside within 1-4 days. In some cases, bruising may occur. You may resume normal activities following the procedure, however, using cosmetics, excessive perspiration and exposure to the sun should be limited until the skin has fully healed. Please see after care instructions for more details.

    • DO NOT touch/rub/traumatize the healing pigmented area with your fingers, they may have bacteria on them and create an infection.

    • Apply Vasaline/Oilment 3-5 times a day with a clean cotton swap.

    • No make-up, tintint/ lifting/extension on lashes, sun, soap, sauna, Jacuzzi, swimming in chlorine pools, or in reaction bodies. 

    • Sun-block is required to prevent fading of color.

    • Do not use products that contain AHA.

    • Sleep on satin pillowcase while healing, if possible.

    • Do not donate blood ONE YEAR from time of procedure.

    • During the scalping process, I understand that I have to avoid being in contact with animal to the best of my ability to avoid cross-contamination/infection.

    • I have been advised that the true color will be seen 4-6 weeks after each procedure, and that the pigment may vary according to skin tones, skin type, age and skin condition.

    • I understand that some skin types accept pigment more readily and no guarantee on exact color can be given.,pI agree to follow all pre-procedure and post-procedure instructions as provided and explained to me by the technician. Failure to do so may jeopardize my chances for a successful procedure. I can confirm that I have received a copy of after care details.

    • I have been informed of the nature, risks, and possible complications and consequences of permanent skin pigmentation.

    • CONTACT YOUR TECHNICIAN IMMEDIATELY IF CONCERNED.

    • If you have excessive redness, swelling, or tenderness or any red streaks going from the procedure site toward the heart, elevated body temperature, or purulent drainage from the procedure site, contact your physician as the area may be infected to seek medical care.

    • 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.

    • I understand the actual color of the 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 an exact science but an art. I request the semi- permanent skin pigmentation procedure(s) and accept the permanence of this procedure as well as the possible complications and consequences of the said procedure.

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