Deluxe Brows® Consent Form
MODEL CONSENT FOR PERMANENT MAKEUP
Full Name Address
Date of birth Email Phone number
DELUXE BROWS is obligated to perform procedures in strict compliance with all hygiene and health protection measures. This information is confidential and it shall also be handled in that way. DELUXE BROWS assumes no liability in case of giving false information.
HEALTH QUESTIONNAIREIn order to perform the tattoo procedure in a safe manner, please answer the following health questions truthfully.Have you ever received a permanent makeup treatment? If yes, how long ago and which area? Do you have any body art (tattoos)? Do you suffer from the following diseases or are you taking any of these medications? Hemophilia Diabetes mellitus (diabetes) Hepatitis A, B, C, D, E HIV + Skin diseases Eczema Allergies List all if yes? Autoimmune diseases Are you prone to herpes? Infectious diseases / high fever Epilepsy Cardiovascular problems Are you taking medication for blood thinning? Are you pregnant or nursing? Are you taking any medications on daily basis? List all if yes Do you have a pacemaker? Do you have problems with healing of wounds? Have you consumed drugs or alcohol in the last 24 hours? Did you undergo any surgery in the last 14 days? Were you exposed to radiation or had any other medical interventions? List all if yes
I agree on photo taking and using the photos for advertising and training purposes. I understand that the taking of before and after photographs ofthe said procedure are a condition of such procedure.
The following risks are specifically explained to the client:
The treatment will be performed by a student, not the trainer or instructor. 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 permanent cosmetics. I acknowledge some of these potential adverse changes may not be correctable. During the procedure despite the staff expertise and all the precautionary measures, injury is possible. Despite the application of the most advanced and the top quality pigments, allergic reaction is possible but rare. The client is informed about this and he/she assumes liability. Notice that tattoo inks, dyes, and pigments have not been approved by the Federal Food and Drug Administration and that the health consequences of using these products are unknown.During and after the procedure temporary swelling, redness and/or itching may occur. Depending on the skin structure after the first treatment small scabs with a loss of pigment may occur and color intensity may change. In the first seven days result might be up to 40% darker and 10-15% thicker. Color i.e. color reflection depends on the natural skin pigment.The pigment is absorbed differently due to differences in the skin quality, thus there is no warranty for the treatment success. The shape is determined according to the face proportions. Depending on the skin structure it should be noted that change in the color intensity is possible and that one or more additional treatments will be required. The minimum or maximum duration of microblading or permanent makeup procedures cannot be determined with certainty, nor can the warranty be given on performed treatment. Any touch ups fees apply for future appointments if touch ups are desired. If most of the color has faded then this will not be considered a touch up and all fees for a new service may apply. Touch ups are usually performed after 6-8 weeks. For oily skin it may be necessary to perform more corrections. Permanent make-up always leads to the skin injury. Therefore, it is important to carefully and gently nurture your skin after the treatment to allow healing without complications. Inadequate care in healing phase of the skin can lead to poor results and DELUXE BROWS and the technicians cannot be liable for it. Permanent Makeup is an art and not science. Client’s result will vary and using a makeup may still be needed.BEFORE THE TREATMENT:
WHAT TO EXPECT IN THE HEALING PROCESS FOR ALL BROW ENHANCEMENT/PERMANENT MAKEUP PROCEDURES.
• WHILE YOUR SKIN HEALS, BE PREPARED FOR THE COLOR INTENSITY OF YOUR PROCEDURE TO BE SIGNIFICANTLY LARGER, SHARPER, BRIGHTER, OR DARKER than what is expected for the final outcome. This is a normal and expected result of the application and healing process. The healing process will take a number of days to complete, depending on how quickly the outer layer of your skin exfoliates and new skin regrows to take its place.• Color will appear darker and bolder after the procedure. Your color will oxidize and darken over the first few days. The color CAN AND WILL fade/soften anywhere from 10% to 50% or more. • Some residual swelling is normal for ALL procedures. Swelling and healing time is individualized. It can be minimal on clients. Every client is different. Blanching (whiteness around the treatment area) and redness is to be expected and can vary from client to client. It can last a few hours to a few days. • The area may appear uneven, dry, itchy, tender, red & irritated. This is all 100% normal. DO NOT PICK. These symptoms will dissipate each day and vary on an individual basis. • Picking can lift color and pigment from the treated area resulting in unevenness and blank spots. Let the brows flake off naturally. • The treated area may not exfoliate evenly. Please do not pick at the scabs. During the exfoliation process, your color may look weak, orangey, pinkish, or grey. This will not be your final result. It takes a full 6 weeks or more for your true color to surface. Please be patient and wait until you are fully healed before you critique your result. Any refinements can be addressed at a follow-up visit. • Healing is specific to each client. It is important to realize that you will need a color boost every 1-2 years to maintain its fresh natural appearance. Fading WILL happen after each procedure. We do not have control over your bodies healing process.• Everyone’s genetics, physiological makeup, and lifestyle will affect the treatment in various unique ways. You may need still to powder and/or pencil your eyebrows even after the healed results. This is an enhancement to your natural brows…. not a permanent one. • If you are out in the sun a lot, have oily skin, use anti-aging creams, Retin-A /retinol products, acidic cleansers, natural elements, regular chemical peels, or exercise frequently, your permanent makeup WILL fade prematurely. The better you take care of the treated area and follow the provided aftercare, the longer it will last. • Remember, that no two sides of the face are the same or perfectly symmetrical. While trying to obtain perfect symmetry is our goal note that nothing is PERFECT. • When you leave the studio your treated area is intact. Remember your technician will do their best to help you heal properly but lifestyle, genetics, age, and certain environmental factors can/will contribute to the retention. • It is very common to have areas fade more so than others. This is part of the healing process and it may be treated at the recommended touch up appointment. Previously done treatments may take 1-3 treatments to achieve the desired result. Scar tissue in the area done multiple times WILL require additional procedures and fees will apply.• Permanent Makeup is an art, NOT a science. All clients’ results will vary. The use of makeup such as a brow pencil or powder may still be needed. This is not a “no maintenance” treatment but a “low maintenance” one. • If you decide to change your mind and switch to a have powder-filled/ombre/shaded eyebrow procedure after your first hair stroke/microblading procedure and do not want to do hair strokes for your follow up appointment, you will be charged accordingly for the change of service. You will/may also be charged a “set-up” fee for your 3rd follow up because the service performed has been changed. • Follow up visits should be done within 6 – 8 weeks after your initial treatment. Any additional touch up’s within 4 – 12 months that require color boost may acquire additional fees. WE DO NOT DO FREE TOUCH UP’s after your FOLLOW UP visit but will price accordingly to your individual needs. • Fees may apply depending on what is needed.
IMPORTANT REMINDERS AFTER TREATMENT
Absolutely NO refunds after any services will be given.
PERFORMED BY TRAINER (Subject to change)Touch-up session $300-$400 (4-8 weeks after first student work)$400 – $750 (6 months – 12 months)Full Price after 12 months
PERFORMED BY STUDENTPrices and terms are set by each student individually
For safety reasons and insurance purposes no accompanying guests, kids and pets are allowed in the studio.
I ACKNOWLEDGE THAT NO GUARANTEES HAVE BEEN MADE TO ME CONCERNING THE RESULTS OF THIS PROCEDURE. I confirm that I have read and understood the above mentioned information. I received a clear and understandable response to all my questions. The treatment procedure and post-treatment care was explained to me in detail and I agree with it. I will be released as a volunteer model and will also be released as a future model or client in the event of improper post-treatment care. I will strictly follow the after care instructions.
I certify I have read and initialed the above paragraphs and have had explained to my understanding this consent and the procedure process. I accept full responsibility for the decision to have this cosmetic tattoo work done. 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, allergic reaction, 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, butan art. I request the microblading/permanent makeup procedure and accept the permanence of the procedure as well as the possiblecomplications and consequences of the said procedure. I understand that while this is sometimes referred to as semi-permanent in nature, due to each individual’s reaction to pigment, the length of time pigment is present cannot be guaranteed. In some cases, the pigment will be permanent.
PLEASE UPLOAD A CLEAR PICTURE OF YOUR FACE (without makeup), focusing on the area you want to have a tattoo done (brows, eyes, lips):
Leave this empty:
Your legal name
Your email address
Signed by Darius Maniusis Signed On: 2019-11-21
If you have questions about the contents of this document, you can email the document owner.
Document Name: Deluxe Brows® Consent Form
Agree & Sign