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The Brow Spot
Consent Form
 

Read and fill out this form completely, being certain that you understand everything to ensure your needs best fits our services. Please be sure to write your contact information clearly.

What procedure are you having? Required

Our clients have the right to be informed so that they can make the decision whether or not to undergo the procedure(s) after knowing the risks involved. This disclosure is simply an effort to keep our clients informed so that they may give, or withhold, their consent to the procedure. 

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Please read the statements below and check the box after to indicate you understand them completely. As a client, it is you responsibility to inform the Technician of all possible concerns/issues before they begin your procedure. 

 

  •  I understand permanent makeup is a form of a tattoo that requires implantation of pigment into my skin using a needle/blade. If I would like to get the tattoo removed I must get it professionally removed.

 

  •  I understand that implanted pigment color can slightly change or fade over time due to circumstances beyond my control, and will need to maintain the color with future applications.

 

  •  I understand there may be risks and hazards related to the performance of this procedure, including, but not limited to: allergic reaction to the pigment and/or other products that will be used, light headedness, bleeding, bruising, swelling, hyper pigmentation, scarring and infection.

 

  • I understand that it is my responsibility to advise my technician of any problems that I (or my doctor) think could occur for any reason (including but not limited to: allergies, illnesses, medications­including aspirin and/or other medications that cause the blood to thin) and I understand that my technician may elect to delay or not go forward with the procedure based on this information.

 

  • No warranty or guarantee has been made to me as a result of this permanent makeup procedure, and although my technician will do their best to make sure I am happy with the result, the final result cannot be guaranteed. Brows are sisters, not twins! Tattooing is considered permanent; however, it will fade overtime and therefore requires touch ups.

 

  •  I understand that Microblading is a semi-permanent cosmetic tattoo application. Although, 30eyebrow microblading is effective in the majority of cases, no guarantee can be made that a specific client will benefit from the procedure and results depend on skin texture, oiliness, and lifestyle. Initially the color will appear more vibrant, stronger, or darker compared to the end result. Usually within 3-7 days the color will fade 30-40%, soften and look more natural. Additional touch ups are likely needed within 8 months to a 1 year depending on my skin and how I care for my new brows.

 

  • I understand that a certain amount of discomfort is associated with this procedure.

 

  • I understand that tanning beds, pools, some skin care products and medications can affect my permanent makeup.

 

  • I will follow all my aftercare instructions provided by The Brow Spot.

Hav you had Botox/Dysport or any fillers in the last two weeks?
Are you currently using, or have used any products containing Rein-A or Hyaluroni Acid?
Do you take any medications that might affect the healing procedure you wish to recieve?
Are you allergic to latex?
Do you have Diabetes?
Do you bleed/scar easily?
Do you have Hepatitis A, B, or C?
Have you ever had a Forehead or Brow Lift?
Are you under the influence of any drugs or alcohol?
Are you breastfeeding?
Do you have an Autoimmune Disorder?
Do you have Oily Skin
Do you use Accutane or any Acne Treatment?
Are you undergong Chemotherapy Radiaton Treatmet?
Do you have or have had Cancer?
Have you recently tanned by booth or salon?
Do you have difficulty numbing?
Are you taking any blood thinners such as Aspirin, Ibuprofen, etc.?
Do you scar easily, or do you hae a keloid due to scarring?

By signing below, the information I have provided above is complete and true to the best of my knowledge. 

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I fully understand the questions, terms, and conditions of this informed consent, Medical History and release agreement, and all questions have been answered.

 

I, certify that this informed consent, medical history, and release agreement was completed by me and that all entries in it and information are true and complete to the best of my knowledge. I also certify that I have been fully informed of the risk of tattooing/permanent makeup application, including but not limited to; infection, scarring, latex gloves, and other products used. Having been informed of the potential risk associated with getting the permanent makeup tattoo, I wish to proceed with the application and I assume any and all risks that may arise from the procedure. I also certify that I take full responsibility and waive any claims against my technician to the fullest extent permitted by law from all liability whatsoever, for any and all claims of causes of action that I, my estate, heirs, executors, or assigns may have for personal injury or otherwise, including, any direct and/or consequential damages, which result or may arise from the application/implantation of permanent makeup pigment for eyebrows whether caused by the negligence or fault of the technician.

Thanks for submitting!

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