MICROSHADING CONSENT    (Be ready to initial this form at your appointment. Feel free to print out the form and have it ready)

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Name: _______________________________                                                                 

Date: _____________

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Please read below and initial after each line. 

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I am 18 years of age or older and I have truthfully represented that undergoing this procedure was my choice. _____

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I  have not  consumed any caffeine, fish oil, vitamin E, alcohol, ibuprofen or aspirin at least 24 hours before my appointment. ______

 

I am NOT pregnant nor nursing. _____

 

I am NOT under the influence of alcohol or recreational drugs. _____

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I am NOT using blood thinners or medications that may increase bleeding during the procedure.  _____

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I do NOT have skin conditions such as severe acne, keloid scarring, facial psoriasis, keratosis, or moles in the procedure area. _____

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I do NOT have diabetes, a history of hemophilia/abnormal bleeding, or any medical condition that may cause difficulties during the healing process. _____

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I do NOT have any type of rash or infection anywhere on my body. _____

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I do NOT have freckles, moles or sunburn in the procedure area.  ______

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I do NOT have any sensitivity to dyes or local anesthetics. _____

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I am currently not taking any medication and/or have a medical condition or allergies that may interact with the pigments or anesthetic cream, it is my responsibility to consult with a doctor prior to booking an appointment if so.______

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Infection is very unusual but always possible with any procedure, particularly in the event that you do not follow the proper care following the procedure. ______

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I acknowledge that if I have any medical condition(s) I  will need a medical note from my doctor.  ______

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After your procedure I realize that the procedure area will be dark and will lighten after healing.  Swelling and/or redness may occur. ______

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I am aware that the eyebrows naturally scab as part of the healing process and continue to exfoliate in the first month. As a result, the color will fade 40-60% as the skin heals and that this is completely normal.______

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I acknowledge that the procedure does not start until I am 100% satisfied with the drawn outline of my eyebrows. ______

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I understand that results vary, and I may or may not need to have a touch up. Depending on desired results and how dark I would like my  results, I may consider a second session. _______