Micropigmentation,Tinting, Ingrown Treatment, & Waxing Consent and Policy Form

Micropigmentation,Tinting, Ingrown Treatment, & Waxing Consent and Policy Form

Please complete this form to provide your consent, medical history, and acknowledgments for micropigmentation services (brows and/or lips), brow tinting, ingrown hair treatment, and face or body waxing.
Client Information

Please provide your basic information.
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Please upload a valid government ID to verify age and identity.

Cancelof
Permanent MakeupTintingFace WaxBody WaxIngrown Hair Treatment
Permanent Makeup Care Instructions for Brows and Lips:
Warning:

Do not undergo any other facial treatments or chemical peels during the healing period. Keep the treated area clean and dry. Avoid touching or picking at the area.
Use gentle, fragrance-free products as recommended by your technician.
Avoid direct sunlight and tanning beds during the healing process.
Do not apply makeup on the treated area until fully healed.
Follow all aftercare instructions provided by your technician for optimal results.
Brow Tinting Warnings and Care Instructions:
Please avoid getting the brow area wet for 24 hours after tinting.
Avoid using exfoliating products or harsh chemicals near the brow area.
If irritation occurs, contact your technician immediately.
Follow all aftercare instructions provided to ensure best results.
Waxing Warnings and Care Instructions (Face and Body):
Avoid sun exposure and tanning for at least 24 hours before and after waxing.
Do not use exfoliating products or harsh chemicals on the waxed area for 48 hours.
Keep the area clean and moisturized with recommended products.
Avoid hot baths, saunas, and intense exercise for 24 hours after waxing.
If irritation or allergic reaction occurs, contact your technician immediately.
Aftercare Instructions

Please read the aftercare instructions carefully. A printed copy will be provided after your appointment.
Medical and Skin Contraindications

Please answer the following questions about your medical history and skin condition.
Pregnant or nursingDiabetesBlood clotting disordersAutoimmune disordersUsing retinols or vitamin EOpen wounds in area of serviceAllergies to vinyl or latexAllergies to pigments or anestheticsSkin conditions (eczema, psoriasis, dermatitis-describe below)Currently taking blood thinnersNone of the aboveOther (please specify)
Do you have any other medical conditions or allergies we should be aware of?
Please list any medications you are currently taking.
Photo Release Consent

Please indicate your preference regarding the use of your photos.
Yes, I consent.No, I do not consent.
Patch Test Completion or Waiver

Please indicate your choice regarding the patch test.
I have completed a patch test and had no adverse reaction.I wish to waive the patch test and accept all responsibility for any allergic reaction.
Tattoo Disclosure (Micropigmentation Only)

Please read and acknowledge the following disclosure.
I acknowledge that I have read and understand the aftercare instructions provided by my technician, and I agree to follow them for optimal healing and results. I have requested a physical copy if desired.
Cancellation Policy

Please review our cancellation policy.
Consent and Signature

Please review and sign to indicate your understanding and agreement.
By signing below, I confirm that the information provided is accurate and complete, and that I understand and agree to all terms and policies outlined above.*

Powered by Jotform SignClear
Should be Empty:

Micropigmentation,Tinting, Ingrown Treatment, & Waxing Consent and Policy Form

Client Information

Aftercare Instructions

Medical and Skin Contraindications

Photo Release Consent

Patch Test Completion or Waiver

Tattoo Disclosure (Micropigmentation Only)

Cancellation Policy

Consent and Signature