CONSENT FORM - Home of Beauty

Full Name

First

Last

Date Of Birth

Address

Postcode

Email Address

Contact Number

Treatment Selection

Ombré Brows
Microblading

Client Acknowledgement (Required)

I absolutely understand that I am entering into a multi treatment contract until my procedure is deemed complete and that I agree to pay all treatment monies up front, I agree that if I decide not to return for additional treatments that my monies will not be refunded to me. I agree I have up to 3 months to return for additional treatments needed and that I will incur a charge after that time.

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I have undergone or been offered an allergy test prior to my treatment and hereby release the technician from any liability related to any allergic reaction or secondary reaction to applied pigments or other products used during or after the procedure or at a later date. Pigments are mainly composed of iron oxide, alcohol, glycerol and water.

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All needles and machine parts used are individually wrapped, sterile and disposed of after each treatment. I accept that whilst in treatment room all universal precautions are taken but my risk of infection begins the moment I leave the centre.

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I confirm I will agree all colours and shape prior to any work commencing, and that the technician will keep a log of colours etc. chosen to assist further visits. I agree to before, drawn and after photographs being taken. These photographs will be stored on my file and not used for any other purpose unless I agree in writing.

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I accept that after the treatment the direct area treated may show signs of swelling, redness and in rare cases bruising. I accept some discomfort.

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I accept that colour chosen and applied may appear darker for up to 7 days after treatment then will start to lighten after, I accept that I need to return for additional applications and that if I don’t return the makeup will fade faster in the skin and additional work will be charged for.

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I confirm I will strictly adhere to the aftercare instructions given to me and only apply aftercare products given to the treated area. I also accept that complications and rejection of pigment are possible if aftercare instructions are not followed and that should I get an infection post treatment that I will immediately visit my GP and accept that this is possibly due to the fact that I do not live in sterile conditions. If I have any concerns I will telephone my technician to discuss.

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I fully understand that colours will stay visible in the skin for 1 to 5 years and in some cases indefinitely. Also, that light-based colours fade faster than dark based colours and that colours change with time, and the technician cannot guarantee the longevity of colour in the skin after each application this varies from person to person. I confirm and accept that should I use sun beds or frequent sun exposure, glycolic acids, aha products that this will fade my colours faster.

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I understand that laser treatments or further surgery may alter my micro pigmentation and I do not hold the technician responsible.

(Required) to that

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I understand that if I have an MRI or CAT scan micro pigmentation may tingle in the treated area this will not affect the treatment.

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I understand that if I wish to change either the colour, thickness or shape after my first application of cosmetic tattooing that additional cost will be incurred as the area will need an additional treatment.

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I confirm that I have not consumed alcohol within the last 24hrs.

Please note that if considering laser hair removal to inform the laser specialist that you have micro pigmentation as laser can drastically change the colour of the treated area if in direct contact.

I hereby consent to the application of micro pigmentation.
I have read and fully understand all the points listed in this procedure consent form.
I accept full responsibility for any complications that may arise during or following the treatment as a direct result of failing to disclose relevant information regarding my health or current medications.
I hereby give my written consent for a micro pigmentation procedure to be applied as requested by me on this consent and procedure agreement
I understand there are no refunds to this service.

Are you currently under the care of a doctor or hospital specialist?

Yes
No

Please provide details

Please list all current medications, including antibiotics, painkillers, blood thinners, or prescription medications.

Have you previously had micropigmentation?

Yes
No

Please provide details

Health Screening (Select all that apply)

Additional Medical Information

Patch Test

I would like a patch test before treatment.
I choose to waive a patch test and proceed at my own risk.

Patch Test Acknowledgements (Required)

I understand that a patch test cannot guarantee that I will never experience an allergic reaction.
I release the technician and salon from liability relating to allergic reactions to pigments or products used during treatment.

Treatment Consent (Required)

I confirm that I am at least 18 years old.
I confirm that I have not consumed alcohol within the previous 24 hours.
I understand temporary redness, swelling, tenderness, or bruising may occur.
I understand that infection is possible if aftercare instructions are not followed.
I understand that laser treatments may alter the appearance of my micropigmentation.
I understand that future MRI or CAT scans may cause temporary sensations in the treated area.
I consent to treatment photographs being taken for clinical records.
I consent to receiving the micropigmentation treatment requested.

Client Image Consent (My images can be used on your socials and websites to celebrate and showcase your artistry )

I consent to the use of my image as described above.
I do not consent

Required declaration

Appointment Date

GDPR Agreement

I consent to having this website store my submitted information so they can respond to my inquiry.