If yes, you must contact your physician for a preventative prescription capsule to prevent a cold sore.

Please read the following statements carefully.

With cosmetic tattooing, re-touch procedures may be required. A healing period of 4-6 weeks is required before a touch up procedure can be performed. On a rare occasion, the pigment may migrate under the skin. Procedure of cosmetic tattooing may be slightly uncomfortable. The pigments will fade. Immediately after the procedure, the pigment can appear 30-50% darker than the desired result. 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 applied if you are pregnant or nursing, or anyone under the age of 18. Infections can occur if aftercare instructions are not followed correctly. There may be swelling and redness following the procedure. You may experience minor bleeding. If you have an MRI scan within 3 months after any cosmetic tattooing procedure, you should notify/discuss with your doctor. Possible scarring may occur, but is extremely rare.

COSMETIC TATTOOING PRE PROCEDURE ADVICE

Please read the following advice carefully and sign at the end

•• COSMETIC TATTOOING procedures normally requires multiple treatment sessions. For best results, clients will be required to return for at least one re-touch appointment. This will take place between 4-6 weeks after 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 after the initial procedure and will reduce by 30-50%.

•• Although numbing cream is used during the procedure, slight sensitivity/discomfort may still be felt by sensitive clients. Delicate or sensitive skin may be red and/or swollen after the procedure.
•• Please wear your normal make up on the day of your procedure.
•• Please do not drink alcohol 72 HOURS prior to the treatment OR use any blood thinning medication including over the counter pain relievers 72 HOURS PRIOR.

•• Where 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

•• A patch test will be performed, unless waived by client.
•• Any brow shaping using waxing should be performed at least 2 WEEKS before the procedure.
•• Electrolysis treatment should be undergone no less than 5 days before the procedure.
•• AHA products and retinoids should be avoided no less than 2 weeks prior to the procedure.
•• Exfoliating treatments such as microdermabrasion should not be performed within 2 weeks prior to procedure.

•• Chemical and laser peels should be avoided no less than 6 weeks prior to procedure.
•• Please wait 2-3 weeks if you have had Botox injections before microblading.

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 Cosmetic tattooing

•• Liver disease – high risk of infection
•• Compromised skin near brow area
•• Cold sores/fever blisters – please take an anti-viral prior to treatment
•• Hormone therapies – can affect pigmentation and/or cause sensitivity
•• 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 high risk of infection.

RECENT EYELID OR EYEBROW SURGERIES DONE BY A CLIENT WITHIN THE LAST 2 MONTHS MUST BE CLEARED BY YOUR DOCTOR PRIOR TO APPOINTMENT.

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 FOR COSMETIC TATTOOING

I am over the age of 18, am not under the influence of drugs or alcohol, am not pregnant or nursing and desire to receive the indicated semi-permanent pigmentation procedure. The general nature of cosmetic micro-pigmentation, as well as the specific procedure to be performed has been explained to me. The COSMETIC TATTOOING procedure requires 2 visits (in some cases more may be required). Scheduled appointments for the touchup procedure require 48 hours notice for cancellation or rescheduling. Outside 8 weeks or if scheduled appointments are missed, an additional charge will be incurred.

» If an unforeseen condition arises in the course of the procedure, I authorize my therapist to use his/her professional judgment to decide what he/she feels is necessary under the given circumstances. I accept the responsibility for determining the color, shape and position of the cosmetic tattooing procedure as agreed during consultation. I fully understand and accept that non-toxic pigments are used during the procedure and that the result achieved may fade over a period of 1-3 years. Even once the color fades, pigment itself may stay in the skin indefinitely.

» I have been informed that the highest standards of hygiene are met and that sterile, disposable needles and pigment containers are used for each individual client, procedure and visit.
» I understand and accept that each procedure is a process requiring multiple applications of pigment to achieve desired results and that 100% success cannot be guaranteed during the first procedure. I understand that I may have to return for a repeated procedure.

» The result of the procedure can be affected by the following: medication, skin characteristics (dry, oily, sun-damaged thick or thin skin type), personal pH balance of your skin, alcohol intake and smoking, 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 email for more details. The procedure results will look acceptable for you to appear in public without additional make-up on the brows.

» I have been advised that the true color will be seen 1 month 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.
» To my knowledge, I do not have any physical, mental or medical impairment or disability that might affect my well being as a direct or indirect result of my decision to have the procedure done at this time.

» I 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. 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.

There is a possibility of an allergic reaction to numbing agent and/or pigments. A patch test is advisable however it does not ensure a client will not have an allergic reaction. I consent or waive the patch test. If waived, I release the technician from liability if I develop an allergic reaction to the pigment.

I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my micropigmentation/microblading procedure. I acknowledge some of these potential adverse changes may not be correctable.

I certify that I have read and initialed the above paragraphs and have had explained to my understanding the consent and procedure permit. I accept full responsibility for the decision to have this cosmetic semi-permanent pigmentation work done.
I give Glam Body Sugaring Boutique LLC permission to perform my cosmetic tattooing procedure.

Consent for Permanent Cosmetics

I hereby request and consent to the application of permanent color and consent to have the following procedures performed by GLAM BODY SUGARING BOUTIQUE,LLC.

I understand that the process used to apply color is not a one step process and REQUIRES subsequent visits to achieve desired results. I further understand that the fee includes my INITIAL visit. A touch up or perfecting session is NOT included in the initial fee. Maintenance touch ups are scheduled as needed and may vary from six months to three years. Fees for maintenance visits, pigment replacements, and scar camouflage are based on an agreed fee.

I understand that with time, pigment can, and will fade and change color according to metabolism, skin type, age, exposure to the sun, smoking, alcohol, medications, RETIN-A, and Glycolic Acids.

I acknowledge, that no guarantees have been made to me concerning the results of this procedure and that the professional recommendation is only a recommedation.

I understand the nature of the procedure and possible complications or adverse affects that may occur as a result of applied pigments or inks. I fully understand this is a tattooing process; therefore not a science, but an art.

I have recieved pre and post procedure instructions and agree to strictly adhere to such instructions.

I accept resonsibilty for determining the color, shape, and position of the pigments that will be applied. I understand the actual color of the pigment or ink may be modified slightly due to the tone and color of my skin.

I understand the taking of photographs, before and after the procedure is required.

** The known possible complications from micropigmentation are: swelling, puffiness, bruising, dry patches and tenderness. It is normal to lose 1/3 of the color during the healing process. After most procedures the color may be a shade too dark; in 5-10 days may appear too light. After 10 days, the color will show more than it did initially. It will appear softer when completely healed (28-60 days) as the color will come from the dermal layer of the skin to the epidermal layer of the skin. In the event of a CAT scan or MRI, please inform your physician of your Permanent Cosmetics Procedure(s) as some pulling or burning sensation may occur during the procedure.

COSMETIC TATTOOING PATIENT PHOTO RELEASE AGREEMENT FOR GLAM BODY SUGARING BOUTIQUE LLC

I hereby consent to, and authorize the use by GLAM BODY SUGARING BOUTIQUE LLC of the specified COSMETIC TATTOOING photographs and/or video; that is, photographs taken before, during and after my microblading procedure.

I understand that my identity will be protected. Unless otherwise noted or spoken my full face may be used, but my name will not be used in conjunction with the photographs and/or video.

I understand, that before,during and after photos will be taken for insurance purposes.

GLAM BODY SUGARING BOUTIQUE LLC has explained that all the photos and/or videos will be clinically appropriate and tastefully presented.

I have agreed on the photographs that GLAM BODY SUGARING BOUTIQUE LLC requests to be used and it is understood that these photos may be used on GLAM BODY SUGARING BOUTIQUE LLC website, social media accounts (Facebook, Instagram, Twitter), and in-office for demonstrational and promotional purposes. I understand that I am not entitled to compensation for these photos being used.

Should I desire to revoke permission for their use in the future, I understand that I must notify GLAM BODY SUGARING BOUTIQUE LLC in writing and allow 30 days to accomplish this removal.

I now release GLAM BODY SUGARING BOUTIQUE LLC and anyone authorized by GLAM BODY SUGARING BOUTIQUE LLC all personal rights and objections I have or may have to the above described uses of my photographs and/or videos. I have entered into this release freely or voluntarily, and agree to be bound thereby.

CANCELLATION/ NO SHOW/ LATE ARRIVAL POLICY

We understand that unplanned issues can come up and you may need to cancel an appointment. If that happens, we respectfully ask for scheduled appointments to be cancelled at least 7 DAYS in advance. Our staff wants to be available for your needs and the needs of all of our clients. When a client does not show up for a scheduled appointment, another client loses an opportunity to be seen and the Esthetician loses the opportunity to make income.

We do have a 15 minute late policy- any arrival after this time period will result in your service either being cancelled or your appointment time cut short. If your appointment is cancelled, you will have to leave a new deposit.

Although we have always had a cancellation policy, circumstances have called for us to enforce a policy for charging for no show appointments and those appointments not cancelled 7 DAYS before your scheduled appointment.

We do thank you for being a valued client, and for your understanding and cooperation.

As of September 1, 2015 the folowing fees will be implemented:

You may RESCHEDULE your appointment without charge up to 7 DAYS before your scheduled appointment.

Same day Cancellations, or anything less than a 7 day period will result in forfeiture of your deposit towards the service.

No call or No Show will result in forfeiture of your deposit, and the need to leave another deposit to book a new appointment.

All Cosmetic Tattooing deposits are non refundable, non transferrable.

Thank you for taking the time to complete this form. Please sign below.