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BROW MICROBLADING CONSENT FORM
First Name
Last Name
NRIC (Last 4 Digits)
Contact Number
Consent
Consent & Release Agreement for Permanent Cosmetic
Consent & Release Agreement for Permanent Cosmetic
This form provides information to assist in making an informed decision of whether or not to undergo a permanent cosmetics application. If you have questions, please don‘t hesitate to ask. Although permanent cosmetic tattooing is effective in most cases, no guarantee can be made that a specific client will benefit from the procedure. This is the process of depositing pigment into the top dermal layer of the skin and is a form of tattooing. All instruments that enter the skin or come in contact with body fluids are sealed and sterilized before use and disposed of after use. Cross contamination guidelines are strictly adhered to.
DECLARATION
I hereby declare that I have been informed, in detail about the Microblading / Ombre shading method and procedure which will be performed. I was informed that needles are used for the treatment to inject colour pigments into the upper layers of the skin.
I hereby declare that I have been informed, in detail about the Microblading / Ombre shading method and procedure which will be performed. I was informed that needles are used for the treatment to inject colour pigments into the upper layers of the skin.
i hereby declare that i am not allergic to Anesthesia: Topical anesthetics are used to numb the area to be tattooed. Lidocaine, Prilocaine, Benzocaine, Tetracaine and Epinephrine in a cream or gel form are typically used.
i hereby declare that i am not allergic to Anesthesia: Topical anesthetics are used to numb the area to be tattooed. Lidocaine, Prilocaine, Benzocaine, Tetracaine and Epinephrine in a cream or gel form are typically used.
I herby declare that i am not diabetic
I herby declare that i am not diabetic
i hereby declare that i am not on Accutane or prescription acne treatment
i hereby declare that i am not on Accutane or prescription acne treatment
i hereby declare i am not prone to keloid scarring
i hereby declare i am not prone to keloid scarring
i hereby declare that i am not allergic to Iodine
i hereby declare that i am not allergic to Iodine
I hereby declare i do not test positive for HIV or Hepatitus Virus
I hereby declare i do not test positive for HIV or Hepatitus Virus
I hereby declare that i am not pregnant / breastfeeding
I hereby declare that i am not pregnant / breastfeeding
I hereby declare that i have had no Botox treatment for the past 28 days
I hereby declare that i have had no Botox treatment for the past 28 days
i hereby declare that i have has no filler injections for the past 3 months
i hereby declare that i have has no filler injections for the past 3 months
I hereby declare that i am not under treatment for Cancer / Radiation / Chemotheraphy
I hereby declare that i am not under treatment for Cancer / Radiation / Chemotheraphy
i hereby declare that i am aware there is NO GUARANTEE for the outcome of my procedure.
i hereby declare that i am aware there is NO GUARANTEE for the outcome of my procedure.
i hereby declare that i do NOT have any of the medical conditions that were mentioned in the above indemnity form.
i hereby declare that i do NOT have any of the medical conditions that were mentioned in the above indemnity form.
I am aware that it is not possible to predict how durable and intensive the brow colour will be and that durability and colour intensity depend on age, skin type and environmental conditions of the treated person.
I am aware that it is not possible to predict how durable and intensive the brow colour will be and that durability and colour intensity depend on age, skin type and environmental conditions of the treated person.
I am aware that the color retention / durability may varies on different skin type and some skin type may not absorb color well and may require more sessions to achieve the desired outcome.
I am aware that the color retention / durability may varies on different skin type and some skin type may not absorb color well and may require more sessions to achieve the desired outcome.
I am aware that the treatment with the pigmenting needles can cause skin irritation and minor inflammation of the skin which usually disappears within 24-36 hours.
I am aware that the treatment with the pigmenting needles can cause skin irritation and minor inflammation of the skin which usually disappears within 24-36 hours.
I hereby declare that I am under FULL UNDERSTANDING that the procedure is a Tattoo and a touch-up Session can only be done after 6 to 8 weeks but within 3 months .
I hereby declare that I am under FULL UNDERSTANDING that the procedure is a Tattoo and a touch-up Session can only be done after 6 to 8 weeks but within 3 months .
I have been informed that the brows will appear darker and thicker within the first 5 days. I have been informed that the section of skin to be pigmented may be anesthetized/numbed with a surface anesthetic.
I have been informed that the brows will appear darker and thicker within the first 5 days. I have been informed that the section of skin to be pigmented may be anesthetized/numbed with a surface anesthetic.
I Hereby certify that i am above 21 years of age to have this service performed on me and if i am below 21 years , i hereby declare that i have already seeked parental consent and approval
I Hereby certify that i am above 21 years of age to have this service performed on me and if i am below 21 years , i hereby declare that i have already seeked parental consent and approval
What to Expect
What to Expect
Generally, the results are excellent. However, a perfect result is not a realistic expectation after an initial application. It is usual to expect a touch-up after the healing is completed ( 6 to 8 weeks ). We recommend 2 sessions to achieve optimal desired results. However in certain cases a third session may be needed with its corresponding fee. Initially the color will appear much more vibrant or darker compared to the end result. Usually within 5-7 days your brows will lose 25% in thickness and the color will lighten 40-50%, soften and look more natural. The pigment will fade somewhat over time and will likely need to be touched-up through the years.
What to Expect
Generally, the results are excellent. However, a perfect result is not a realistic expectation after an initial application. It is usual to expect a touch-up after the healing is completed ( 6 to 8 weeks ). We recommend 2 sessions to achieve optimal desired results. However in certain cases a third session may be needed with its corresponding fee. Initially the color will appear much more vibrant or darker compared to the end result. Usually within 5-7 days your brows will lose 25% in thickness and the color will lighten 40-50%, soften and look more natural. The pigment will fade somewhat over time and will likely need to be touched-up through the years.
Aftercare
Refrain from touching the treated area.
Refrain from touching the treated area.
Avoid IPL / Laser Treatment during healing period
Avoid IPL / Laser Treatment during healing period
Refrain soaps , cleanser, cream or make up on the treated area for 3 days
Refrain soaps , cleanser, cream or make up on the treated area for 3 days
• Apply the aftercare ointment with a Q-tip. Use the ointment very sparingly. Never touch the procedure area without washing your hands immediately
• Apply the aftercare ointment with a Q-tip. Use the ointment very sparingly. Never touch the procedure area without washing your hands immediately
• Do not scrub, rub or pick at the epithelial crust that forms. Allow it to flake off by itself. If it is removed before it is ready the pigment underneath it can be pulled out.
• Do not scrub, rub or pick at the epithelial crust that forms. Allow it to flake off by itself. If it is removed before it is ready the pigment underneath it can be pulled out.
• After the 7 to 10 days healing period, always use a sun block after the procedure area is healed to protect from sun fading. Maintaining proper skin care is suggested to help keep your brows as vibrant and fresh as possible. This means cleansing, exfoliating, and moisturizing the brow area is recommended.
• After the 7 to 10 days healing period, always use a sun block after the procedure area is healed to protect from sun fading. Maintaining proper skin care is suggested to help keep your brows as vibrant and fresh as possible. This means cleansing, exfoliating, and moisturizing the brow area is recommended.
• If you have any signs and symptoms of infections we advise for you to seek medical care.
• If you have any signs and symptoms of infections we advise for you to seek medical care.
IMPORTANT - PLEASE ACKNOWLEDGE
*
I understand that successful color saturation can NOT be guaranteed. I acknowledge that the proposed procedure(s) involve risks inherent in the procedure and have possibilities of complications during and/or following the procedures such as: infection, poor color retention and hyper-pigmentation. *
I understand that successful color saturation can NOT be guaranteed. I acknowledge that the proposed procedure(s) involve risks inherent in the procedure and have possibilities of complications during and/or following the procedures such as: infection, poor color retention and hyper-pigmentation. *
I acknowledge it is not reasonably possible for my technician to determine whether I might have an ALLERGIC reaction to the pigments, anesthetic or ointment used in this process. I agree to forego a patch test and accept the risk that such reaction is possible. *
I acknowledge it is not reasonably possible for my technician to determine whether I might have an ALLERGIC reaction to the pigments, anesthetic or ointment used in this process. I agree to forego a patch test and accept the risk that such reaction is possible. *
All touchup sessions must be completed 12 weeks from initial session. Failure to make this appointment will incur its corresponding fee or forfeited touchup session. Touch up can only be done after 6 to 8 weeks
All touchup sessions must be completed 12 weeks from initial session. Failure to make this appointment will incur its corresponding fee or forfeited touchup session. Touch up can only be done after 6 to 8 weeks
All touchup sessions must be completed 12 weeks from initial session. Failure to make this appointment will incur its corresponding fee or forfeited touchup session. Touch up can only be done after 6 to 8 weeks
i understand that the therapist will recommend and draw the ideal eyebrow shape according to my features, however i am free to change the shape as i desire and understand the shape will be final and cannot be changed after the procedure . As brow are very subjective to individual , The final brow shape decision / approval will be myself and not decided by my brow therapist . In the event if i am unable to decide the shape , TLC will not proceed with the session.
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