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Microblading Consent Form

This document is a consent form for eyebrow microblading. It states that the client is over 18, not under the influence, and desires to have microblading performed. It explains that microblading is a permanent procedure that can result in risks like infection, inconsistent color, or fading over time. It also notes that follow up treatments will be needed and that the client will strictly follow all pre and post procedure instructions. The client acknowledges being informed of the procedure and possible complications, and consents to having their photo taken before and after.

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ruth njenga
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191 views

Microblading Consent Form

This document is a consent form for eyebrow microblading. It states that the client is over 18, not under the influence, and desires to have microblading performed. It explains that microblading is a permanent procedure that can result in risks like infection, inconsistent color, or fading over time. It also notes that follow up treatments will be needed and that the client will strictly follow all pre and post procedure instructions. The client acknowledges being informed of the procedure and possible complications, and consents to having their photo taken before and after.

Uploaded by

ruth njenga
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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CONSENT FOR EYEBROW MICROBLADING PROCEDURE

NAME DATE DOB

ADDRESS CITY

STATE ZIP HOME PH. WORK PH.

I, am over the age of 18, am not under the influence of drugs


or alcohol and desire to microblading of eyebrows performed. The general nature of
cosmetic tattooing as well as the specific procedure to be performed has been explained
to me. X

NO. OF VISITS REQUIRED: COST OF PROCEDURE(s):

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, but an
art. I request the microblading procedure and accept the permanence of the procedure as
well as the possible complications and consequences of the said procedure. I understand
that while this is sometimes referred to as semi-permanent in nature, due to each
indivudal’s reaction to pigment, the length of time pigment is present cannot be
guaranteed. In some cases, pigment will be permanent. X

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. X

I have received pre- and post procedure instructions and I will strictly adhere to such
instructions. I understand that my failure to do so may jeopardize my chances for a
successful procedure. If I am on any medication for depression or any other mood
altering prescription, I will advise my technician. X

I understand that the taking of before and after photographs of the said procedure are a
condition of such procedure. 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.

CLIENT: DATE

TECHNICIAN DATE

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