I hereby agree that everythinhg completed above is true. I also agree that any changes to the above information, I will notify Lash & Brow Co. prior to the service.
I have agreed to have eyelash extensions applied and/or removed from my eyelashes. Before Lash & Brow Co. can perform this procedure, I understand that I must complete this agreement and provide my consent by signing and dating this consent form where indicated.
I understand that there are risks associated with having artificial eyelash extensions applied to and/or removed from natural eyelashes.
I understand that the eyelash extensions will be applied to the natural lash as determined by the technician so as not to create excessive weight on the natural eyelash thereby preserving the health, growth and natural look of the clients natural eyelashes.
I understand that a part of the procedure eye irritation, eye pain, eye itching, discomfort and in rare cases, eye infection may occur.
I understand and agree that if i experience any of these issues with my lashes that I will contact the technician and have the eyelashes removed immediately and consult a physician at my own expense.
I understand that even though the technician may apply and remove the eyelashes properly, the adhesive and/or materials may become dislodged during or after the proceudre, which may irritate the eyes or require further follow up care.
I understand that eyelash extensions will require 're-fills' on a regular basis at an additonal cost.
I understand and agree to follow the aftercare instructions provided by the technician. Failure to follow the aftercare instructions can cause the eyelash extensions to fall out and/or cause eye irritation/infection.
I understand that in order to have the eyelash extensions applied to my eyelashes I will need to keep my eyes closed for a duration of 60-120 minutes during the procedure. I also understand that i will ned to be lying in a reclined position. Any medical conistions that might be aggavated by lying still for a prolonged period of time may mean I will not be able to have the procedure performed on my eyes.
This agreement will remain in effect for the procedure and all future procedures conducted at Lash & Brow Co. I understand that this agreement is binding and that I have read and fully understand all information listed above. I agree that I am over the age of 18 years. (If under 18 years of age, a parent or guardian must also sign this form.)
Please fill in this declaration of consent. This information is for your own safety and is subject to the current data protection regulations. You have to read and sign this declaration of consent before each treatment.
If you are affected by one of these conditions, please consult your doctor. Legal action may be taken if information is withheld that could put other customers or the stylist at risk.
1. The durability of microblading depends on the individuals skin texture and condition and on the skins metabolism. It is therefore not possible to guarantee durability or that the colours won’t fade. Durability depends on a number of factors: skin texture and condition, correct follow-up care by the customer, as well as choice of colour/intensity. Unwanted colour changes cannot be ruled out.
2. After the treatment, the pigmented area will appear more intense and the customer may experience swelling, redness, crusting and sensation of tightness. Please follow the care instructions for approx. 2 weeks after the treatment.
3.The result of the treatment only becomes visible once the healing process is complete; this takes approx. 2 to 4 weeks. Since we all heal differently and have different metabolisms, one or more follow-up treatments may be necessary. In some isolated cases, the desired outcome may not be achieved because sometimes the skin does not absorb the colour pigments regularly or even at all. In some rare cases, the colour may run. It is therefore not possible to guarantee a successful treatment.
4. Please protect the pigmented areas from intense UV radiation (eg: sessions at the solarium), and use our after-care cream. In the first 2 weeks, you should also avoid high levels of air moisture (eg: a sauna visit)
5. If you have had permanent make-up treatment before and we correct or re-touch it, please be aware that it is possible for the deeper and older colour to reappear after a while, or for its colour to dominate because of its chemical composition. We can therefore not guarantee the success of the treatment.
6. In rare cases, the area treated with microblading can warm up during an MRI scan. We recommend to advise your medical team that you have had such procedures done prior to commencing the scan.
7. In rare cases, allergic or allergy-like reactions can occur (granuloma, permanent skin changes, dryness, pigment disorders, sensitivity, swelling, flaking) as skin irritations as a reaction to the colour pigments. We can therefore not guarantee the tolerability of the colour pigments.
8. Microblading can only be removed by medical specialists using the latest laser technology. White colour pigments cannot be removed, and complete removal cannot be guaranteed.
9. Microblading at Lash & Brow Co. can only be performed on clients over the age of 18.
I confirm that I have read and understood this declaration of consent, and that I have been given the care instructions and that I will follow the instructions it contains. Colour choice and shape were discussed in detail and defined together with me. I agree to undergo microblade treatment, I have been told about the treatment process, and any risks have been fully explained to me. I undergo the treatment at my own risk.
Dermaplaning is a simple, quick, and safe procedure for exfoliating the epidermis and ridding the skin of vellus hair (peach fuzz) by shaving the skin with a sterile blade; it has few to no adverse effects. Using a special and delicate touch, the therapist simply abrades the surface of the skin using light feathering strokes. It is most often used on clients with rough, dry skin, and/or superficial hyperpigmentation to enhance over all skin tone. It is a safe treatment for lients who are pregnant or nursing who want a deep exfoliation. This treatment may be reccomended to prepare the skin for a chemical peel as it allows products to penetrate more readily into the deeper layers. Results may not be seen in a single treatment. Follow-up maintenance treatments may be reccomended.
Risks and Side Effects:
Dermaplaning can create scraping, nicking and/or abrading of the skin.Many clients are often concerned that the hair will grow back heavier and darker after dermaoplaning. This is not the case. Hair will grow back at the same rate and texture as before the treatment within 4-6 weejs.Clients who have inflamed acne or are allergic to nickel are not ideal candidtates for this treatment.Dermaplaning can be done as often as 2 weeks although it is usually done when the vellus hair starts to grow back which is generally in a months time.Some patients may experience redness, irritation, dryness, post treatment acne flares, or folliculitis.Blemishes may result after this treatment.
Immediately after treatment:
It is normal for the skin to appear red and inflamed. Light scabs may form in the treated area and remain for 24-48 hours.Discontinue use of all topical products for 72 hours following treatment.Use a gentle moisturiser as neededCleanse skin with a mild cleanserDo not use heavt make up for the first dayAvoid excessive sun exposure and wear sunscreen daily of SPF30 or higher.
I confirm that I have read and understood this declaration of consent, and that I have been given the care instructions and that I will follow the instructions it contains. I agree to undergo dermaplaning treatment/s. I undergo the treatment at my own risk.
GENERAL: I acknowledge that I am purchasing a self-administered teeth whitening kit that is designed to whiten the colour of my teeth. As a part of the purchase, I am asking for assistance in the use of my teeth whitening kit, and I understand that I will be allowed to use a specially designed LED Lamp in order to accelerate the whitening process. Most natural teeth can benefit from a teeth-whitening treatment, I understand that everyone’s teeth are different and that results will vary. I understand that people with yellowish teeth generally get the best results and that if my teeth have spots due to tetracycline use (grayish tint) or fluorosis, these will be difficult to whiten. Also, if I have artificial teeth, caps, crowns, veneers, porcelain, composite or other restorative materials, I shouldn’t expect dramatic results from this treatment because the peroxide gel will not whiten (or damage) artificial dental work. Also, I am aware that my teeth will never be whiter than the white colour my genes naturally allow. Potential risks although whitening treatments are generally safe, I understand that some of the potential complications of this treatment include, but are not limited to:
GUM/LIP IRRITATION: Whitening gel that comes in contact with gum tissue or the lips during the treatment may cause inflammation or whitening of these areas. This is due to inadvertent exposure of small areas of those tissues to the whitening gel. The inflammation and/or whitening of gums and lips is transient, and the colour change of the gum tissue should reverse within 30 minutes. I may feel a stinging and tingling sensation on these soft tissues during the treatment if the gel comes in contact with them.
TOOTH SENSITIVITY: Although uncommon, some customers can experience some tooth sensitivity during the first 24 hours after the whitening treatment. People with existing sensitivity, recently cracked teeth, micro-cracks, open cavities, leaking fillings, exposed roots, or other dental conditions that cause sensitivity may find that those conditions increase or prolong tooth sensitivity after the treatment.
SPOTS OR STREAKS: Some customers may develop white spots or streaks on their teeth due to calcium deposits that naturally occur in teeth. The peroxide gel does NOT cause these spots. The gel just brings the already existing calcium deposits out and makes them visible again. These usually diminish over time.
RELAPSE: After the treatment, it is natural for teeth colour to regress somewhat over time. This is natural and should be very gradual, but it can be accelerated by exposing the teeth to various staining agents, such as coffee, tea, tobacco, red wine, colas, etc. I realize that I should not eat or drink anything except water during 60 minutes after the treatment because the gel opens the pores of my enamel and makes my teeth very vulnerable to staining agents. I understand that the results of the treatment are not intended to be permanent and that secondary, repeat or touch-up treatments may be needed for me to maintain the colour I desire for my teeth.
ELIGIBILITY: I understand that this treatment CANNOT be used by pregnant or lactating women, people under the age of 16, people with gum disease, open cavities, leaking fillings, or other dental conditions, or people with a known allergy to peroxide and/or to aloe vera. I am not currently taking photoreactive drugs or have consulted with my physician about the use of an LED accelerator lamp with these treatments (Chlorthiazide, Hydrochlorothiazide, Chlorthalidone, Naprosyn, Oxaprozin, Nabumetone , Pirozicam, Doxycycline, Ciprfloxacin, Ofloxacin, Psoralens, Democlocyline, Norfloxacin, Sparfloxacin, Sulindac, Tetracycline, St. John’s Wart, Isotretinoin, Tretinoin). People that have had braces removed should wait for cement residue to wear off before getting a teeth whitening treatment and people with a piercing or other metal objects in the oral cavity should remove them before the treatment as they may turn black. If I feel a sharp pain on a particular tooth during the treatment I should stop the treatment and contact my dentist since this could be a sign of an open cavity.
By signing this document, I indicate that I am not ineligible as per the criteria listed above, that I have read and fully understand this entire document including the possible risks, complications and benefits that can result from the treatment, and that I am performing this treatment under my own responsibility and will not hold Lash & Brow Co., its owners, suppliers or any of its employees liable for any of the above risks that I may experience. I also certify that I have healthy teeth and gums.