3D Lash & Brow Salon & Academy

Microblading Consent Form 

Have you received chemotherapy or radiation in the past year?
Have you ever had an allergic reaction to any of the following:
Are you currently taking Blood thinner medication ?
Do you have active cold sores ?
Are you currently under the care of a physician?
Do you take antibiotics when going to the dentist?
Have you ever had one of the following :;

Please read the following statements carefully. Microblading is a way of cosmetic tattooing, intended to be semi permanent lasting average 12-18 months. On a rare occasion, the pigment may migrate under the skin. Procedure of microblading may be uncomfortable. Although extremely rare, there might be an immediate or delayed allergic reaction to pigment. A negative patch test result does not guarantee that you will not develop an allergic reaction after the full procedure. Allergic reactions to anesthetic can occur. Permanent cosmetics cannot be performed if you are pregnant or nursing, or anyone under the age of 18. Infections can occur if aftercare instructions are not followed correctly. There may be swelling and redness following the procedure. You may experience minor bleeding. If you have an MRI scan within 3 months after microblading procedure, you should notify/discuss with your doctor. Possible scarring may occur.

PLEASE READ THE FOLLOWING NOTICE:
You are hereby notified of the possible risks and dangers associated with the application of each tattoo.  These risk and dangers include, but are not limited to, at least the following:
I. the possibility of discomfort or pain;
II. the permanence of the markings;
III. the risk of infection; and
IV. the possibility of allergic reaction to the pigments or other materials used.   
NO PERSON MAY BE TATTOOED WHO APPEARS TO BE UNDER THE INFLUENCE OF ALCOHOL OR DRUGS

By checking each field, you agree to said statement

Thanks for submitting!

I have received after care information and I’m fully aware of the after care procedures. I fully understand the information provided above & confirm that all information provided by me is correct and truthful. 
I agree to the terms of service.

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