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Studio Sohn

Client Consent Form

Procedure: microblading Procedure Fee $ 500 initial appointment, $100 6-8 week touch up 

Practitioner makes no attempt to, or claim to, practice medicine. Some individuals will have complications related to permanent makeup application. These complications are usually mild and last only a few days. However, extreme complications are always a possibility. If you are healthy and there are no visible reasons restricting you from receiving a tattoo, you must approve of the design and color before the application of your permanent makeup.

To avoid unforeseen complications, please answer the following questions.

I understand that the practitioner that I chose will do my initial procedure and also my touch and yearly as well, unless stated by other wise by staff from Studio Sohn. I understand that this is a two-part procedure and that the final result will show after 28 days of healing and that the result depends on the skin, aftercare, and any health conditions that I may have will vary in result to my eyebrows. I also understand that there will be no issue of a refund after today's procedure.

Informed Consent Form

I hereby authorize Sarah Sohn to perform upon myself permanent cosmetic enhancement. If any unforeseen condition arises in the course of the procedure(s) I further request and authorize her to use her full judgement and do whatever he/ she deems advisable and necessary in the circumstances.


I understand that permanent cosmetic enhancement is an advanced form of tattooing. I accept responsibility for determining the color, shape and position of the enhancement as agreed during the course of my consultation. 


I understand that permanent cosmetics are permanent and that if I choose to have them removed, it may be expensive and leave scars. 


I understand that a sensitivity test for pigment does not guarantee that I will not have an allergic response. I am aware of that allergic response to pigment is rare and accept all responsibility if allergic response occurs. I am aware that a sensitivity reaction to anesthetics can occur and accept all responsibility if allergic response occurs. I fully understand and accept that non-toxic pigments are used during the procedure and that the cosmetic enhancement achieved may fade over the course of 1-3 years. Even though the color has faded, the pigment will stay in the skin indefinitely and may leave a light residue of color. I understand that dyes, inks and pigments are not approved by the Food and Drug Administration (FDA) and the health effects are not known. I accept that the highest standards of hygiene are met, and that sterile disposable needles are used for each individual client, procedure and visit. 


I understand and accept that each procedure is a process requiring multiple applications of pigment to achieve desirable results, and that 100% success cannot be guaranteed. I understand that this is why I need to return for a control procedure that is not included in the initial price. I understand that the pigment may migrate under the skin, however this is a rare occurrence. I understand that permanent cosmetic enhancement is an invasive procedure and the infusion process can be uncomfortable.


I understand that the control procedure, if required, will be performed 1-3 months after the initial procedure and that after a 3-month period I will be charged an additional fee for any procedures. I understand that a control procedure takes place 3- 8 weeks after the initial application to allow the procedure site to fully heal. I will book the appointment when it is convenient for both parties.


I am aware that the result of the procedure is determined by the following: Medication, Skin Characteristics - i.e. dry/oily/sun-damaged, Natural skin undertones, Alcohol intake and smoking, General stress, A compromised immune system, Poor diet, Post procedure care treatment


I have been advised that upon completion of the procedure there may be swelling and redness of the skin, which will subside within 1-4 days dependent on lifestyle. In some cases bruising can occur.


I understand that immediately after the procedure the enhancement can be 30 to 50% darker than the desired result. I understand that the true color will be visible 1 month after each application, and that the color may vary according to skin tones, skin type, age and skin conditions. I appreciate that some skins accept color more readily than others and no guarantee of an exact effect or color can be given.


I understand that scar camouflage procedures require skin color-matching tests before the procedure commences and will not give the result of an undetectable scar. I understand that there are few effective methods for pigment removal. Laser removal has proven successful, however is a process.


I agree to inform my doctor of my permanent cosmetic enhancement if I require a MRI scan within a 3 month period of receiving the procedure.


I confirm that potential complications for the procedure undertaken, and aftercare instructions have been explained to me. A written aftercare advice sheet containing more detailed information has been given to me and I agree that it is my responsibility to read this and follow the instructions on it, until the site has healed.


I confirm that I am over the age of consent for this procedure (i.e. 18 years old for tattoos) and that I am not currently under the influence of alcohol or drugs.


I agree to follow all pre-procedure and post-procedure instructions as provided and explained to me by the practitioner. I understand that infection and possible scarring can occur if I do not adhere to the said instructions. To my knowledge I do not have any physical, mental, or medical impairment or disability that might affect my well being as a direct or indirect result of my decision to have the procedure done at this time. I am at least 18 years old. I am not under the influence of drugs or alcohol. I also consent to the taking of “before” and “after” photographs of said procedure(s)


I CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE CONSENT FORM AND THAT I HAVE REQUESTED TO HAVE PERMANENT COSMETIC ENHANCEMENT OF MY OWN FREE WILL.


Photo & Video Consent and Release Form

Without expectation of compensation or other remuneration, now or in the future, I hereby give my consent Sarah Sohn and Studio Sohn, its affiliates and agents, to use my image and likeness and/or any interview statements from me in its publications, advertising or other media activities (including the Internet). This consent includes, but is not limited to

(a) Permission to interview, film, photograph, tape, or otherwise make a video reproduction of me and/or record my voice;

(b) Permission to use my name

(c) Permission to use quotes from the interview(s) (or excerpts of such quotes), the film, photograph(s), tape(s) or reproduction(s) of me, and/or recording of my voice, in part or in whole, in its publications, in newspapers, magazines and other print media, on television, radio and electronic media (including the Internet), in theatrical media and/or in mailings for educational and awareness.

This consent is given in perpetuity, and does not require prior approval by me.

April 25, 2025

COMPANY POLICY

Everyone's time is valuable and to ensure that I can provide for all my clients the best possible, I please ask everyone to arrive on time. If you are to be late please be aware that if you are more than 15 mins late you will have to reschedule because thiof service can not be rushed or cut short and deposit will be forfeited.

If you need to cancel or reschedule, please do so 72 hours before your appointment.

  • I reserve the right to charge 50% of the service if the appointment is cancelled or rescheduled within 48hrs.
  • I reserve the right for all deposits/exchanges to be non-refundable.

***First time clients must deposit $100 to secure appointment.

Today's Date: April 25, 2025

First Clients's Name

First Name*

Last Name*

Phone*
First Clients's Date of Birth*
First Clients's Information
Are you over the age of 18?*
No
Yes

Age *
Have you had any alcohol within the last 72 hours before your appointment?*
No
Yes
Have you had any aspirin or blood thinning products within the last 7 days?*
No
Yes

Any mood altering drugs within the last 8 hours (Xanax, Prozac, Wellbutrin) etc... *
Do you take prescription drugs?*
No
Yes
Do you have any history of cold sores, herpes or fever blisters?*
No
Yes
Are you sensitive/allergic to latex?*
No
Yes
Do you have problems with healing? Do you scar easily?*
No
Yes
Do you bleed easily from minor skin injuries?*
No
Yes
Previous problems with tattoos or has your physician advised you not to have a tattoo at this time?*
No
Yes
Are you allergic to any metal? (Can you only wear 14k gold?)*
No
Yes
Have you ever had any permanent makeup procedures before, prior to coming to Studio Sohn?*
No
Yes
Are you allergic to topical antibiotic numbing creams?*
No
Yes

Are you taking any vitamins? *
Are you pregnant or nursing?*
No
Yes
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes

Do you have any drug allergies? If yes, Please print in the space provided below *
Are you currently taking medication for high or low blood pressure?*
No
Yes
Do you intentionally tan-direct sun or tanning bed?*
No
Yes
Have you experienced Hepatitis or Jaundice during the past 12 months?*
No
Yes

If you check off more than 3 of the following questions above, you checking off the box(es) does not indicate you are not an acceptable candidate for permanent cosmetics. It may simply be information that is valuable to your technician as each person's body is unique, or it may indicate that based on health conditions that affects healing, it would be advisable or required for you to consult with your physician before proceeding. If this form has not addressed a medical condition you have, please list it here below.

List all the medications you have been taking in the last 6 months *

Have you taken any of the following in the last 2 days; Aspirin, Ibuprofen, Alcohol? *
Have you received chemotherapy or radiation treatment in the last year?*
No
Yes

Name of Doctor:

List of recent surgery's *
Allergies: have you ever had an allergic reaction to any of the following:
Antibiotic ointments
Medication
Drugs
Paints
Latex Rubber
Metals
Foods
Crayons
Nuts
Hair dyes
Lidocaine
Glycerin
Have you had a dental injection to numb your mouth?*
No
Yes
Do you give blood?*
No
Yes
Prior to dental procedures do you receive antibiotic therapy?*
No
Yes
Please fill out the following table with a check to indicate if any of the following
Abnormal Heart Condition
Mitral Valve Prolapsed
Rheumatic Fever
Artificial Heart Valves
Hemophilia
High Blood Pressure
Circulatory Problems
Epilepsy
Thyroid Disturbances
Kidney Disease
Stomach Ulcers
Cancer
Stroke
Prosthetic Hip or Joint
Hepatitis
Keloid Scars
Sensitivity to Cosmetics
Dry Eyes
Alopecia
Watery Eyes
Eyelid Surgery
Trichotillomania
Cold Sores (herpes simplex)
Acutance within 6 months
Fat Injections
Chemical or laser peel within 6 months
Retin A within 6 months
Palpitations
Heart Murmur
Pacemaker
Anemia
Prolonged Bleeding
Low Blood Pressure
Diabetes
Fainting Spells or Dizziness
Liver Disease
Glaucoma
Tumours, Growths or Cysts
Tuberculosis
HIV
Systemic Lupus Erythematosus
Shingles
Bruise or Bleed Easily
Do you tan regularly?
Do you suffer from eye Infections
Ocular Herpes
Do you have Healing Problems
Chapped Lips
Recent Hair Loss
Steroids within 6 months
Dermal Fillers i.e restylane
Botox Enhancement
Asthma
Do your scars heal a darker colour than the rest of your skin?
First Clients's Signature*
Second Clients's Name

First Name*

Last Name*
Second Clients's Date of Birth*
Second Clients's Information
Are you over the age of 18?*
No
Yes

Age *
Have you had any alcohol within the last 72 hours before your appointment?*
No
Yes
Have you had any aspirin or blood thinning products within the last 7 days?*
No
Yes

Any mood altering drugs within the last 8 hours (Xanax, Prozac, Wellbutrin) etc... *
Do you take prescription drugs?*
No
Yes
Do you have any history of cold sores, herpes or fever blisters?*
No
Yes
Are you sensitive/allergic to latex?*
No
Yes
Do you have problems with healing? Do you scar easily?*
No
Yes
Do you bleed easily from minor skin injuries?*
No
Yes
Previous problems with tattoos or has your physician advised you not to have a tattoo at this time?*
No
Yes
Are you allergic to any metal? (Can you only wear 14k gold?)*
No
Yes
Have you ever had any permanent makeup procedures before, prior to coming to Studio Sohn?*
No
Yes
Are you allergic to topical antibiotic numbing creams?*
No
Yes

Are you taking any vitamins? *
Are you pregnant or nursing?*
No
Yes
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes

Do you have any drug allergies? If yes, Please print in the space provided below *
Are you currently taking medication for high or low blood pressure?*
No
Yes
Do you intentionally tan-direct sun or tanning bed?*
No
Yes
Have you experienced Hepatitis or Jaundice during the past 12 months?*
No
Yes

If you check off more than 3 of the following questions above, you checking off the box(es) does not indicate you are not an acceptable candidate for permanent cosmetics. It may simply be information that is valuable to your technician as each person's body is unique, or it may indicate that based on health conditions that affects healing, it would be advisable or required for you to consult with your physician before proceeding. If this form has not addressed a medical condition you have, please list it here below.

List all the medications you have been taking in the last 6 months *

Have you taken any of the following in the last 2 days; Aspirin, Ibuprofen, Alcohol? *
Have you received chemotherapy or radiation treatment in the last year?*
No
Yes

Name of Doctor:

List of recent surgery's *
Allergies: have you ever had an allergic reaction to any of the following:
Antibiotic ointments
Medication
Drugs
Paints
Latex Rubber
Metals
Foods
Crayons
Nuts
Hair dyes
Lidocaine
Glycerin
Have you had a dental injection to numb your mouth?*
No
Yes
Do you give blood?*
No
Yes
Prior to dental procedures do you receive antibiotic therapy?*
No
Yes
Please fill out the following table with a check to indicate if any of the following
Abnormal Heart Condition
Mitral Valve Prolapsed
Rheumatic Fever
Artificial Heart Valves
Hemophilia
High Blood Pressure
Circulatory Problems
Epilepsy
Thyroid Disturbances
Kidney Disease
Stomach Ulcers
Cancer
Stroke
Prosthetic Hip or Joint
Hepatitis
Keloid Scars
Sensitivity to Cosmetics
Dry Eyes
Alopecia
Watery Eyes
Eyelid Surgery
Trichotillomania
Cold Sores (herpes simplex)
Acutance within 6 months
Fat Injections
Chemical or laser peel within 6 months
Retin A within 6 months
Palpitations
Heart Murmur
Pacemaker
Anemia
Prolonged Bleeding
Low Blood Pressure
Diabetes
Fainting Spells or Dizziness
Liver Disease
Glaucoma
Tumours, Growths or Cysts
Tuberculosis
HIV
Systemic Lupus Erythematosus
Shingles
Bruise or Bleed Easily
Do you tan regularly?
Do you suffer from eye Infections
Ocular Herpes
Do you have Healing Problems
Chapped Lips
Recent Hair Loss
Steroids within 6 months
Dermal Fillers i.e restylane
Botox Enhancement
Asthma
Do your scars heal a darker colour than the rest of your skin?
Third Clients's Name

First Name*

Last Name*
Third Clients's Date of Birth*
Third Clients's Information
Are you over the age of 18?*
No
Yes

Age *
Have you had any alcohol within the last 72 hours before your appointment?*
No
Yes
Have you had any aspirin or blood thinning products within the last 7 days?*
No
Yes

Any mood altering drugs within the last 8 hours (Xanax, Prozac, Wellbutrin) etc... *
Do you take prescription drugs?*
No
Yes
Do you have any history of cold sores, herpes or fever blisters?*
No
Yes
Are you sensitive/allergic to latex?*
No
Yes
Do you have problems with healing? Do you scar easily?*
No
Yes
Do you bleed easily from minor skin injuries?*
No
Yes
Previous problems with tattoos or has your physician advised you not to have a tattoo at this time?*
No
Yes
Are you allergic to any metal? (Can you only wear 14k gold?)*
No
Yes
Have you ever had any permanent makeup procedures before, prior to coming to Studio Sohn?*
No
Yes
Are you allergic to topical antibiotic numbing creams?*
No
Yes

Are you taking any vitamins? *
Are you pregnant or nursing?*
No
Yes
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes

Do you have any drug allergies? If yes, Please print in the space provided below *
Are you currently taking medication for high or low blood pressure?*
No
Yes
Do you intentionally tan-direct sun or tanning bed?*
No
Yes
Have you experienced Hepatitis or Jaundice during the past 12 months?*
No
Yes

If you check off more than 3 of the following questions above, you checking off the box(es) does not indicate you are not an acceptable candidate for permanent cosmetics. It may simply be information that is valuable to your technician as each person's body is unique, or it may indicate that based on health conditions that affects healing, it would be advisable or required for you to consult with your physician before proceeding. If this form has not addressed a medical condition you have, please list it here below.

List all the medications you have been taking in the last 6 months *

Have you taken any of the following in the last 2 days; Aspirin, Ibuprofen, Alcohol? *
Have you received chemotherapy or radiation treatment in the last year?*
No
Yes

Name of Doctor:

List of recent surgery's *
Allergies: have you ever had an allergic reaction to any of the following:
Antibiotic ointments
Medication
Drugs
Paints
Latex Rubber
Metals
Foods
Crayons
Nuts
Hair dyes
Lidocaine
Glycerin
Have you had a dental injection to numb your mouth?*
No
Yes
Do you give blood?*
No
Yes
Prior to dental procedures do you receive antibiotic therapy?*
No
Yes
Please fill out the following table with a check to indicate if any of the following
Abnormal Heart Condition
Mitral Valve Prolapsed
Rheumatic Fever
Artificial Heart Valves
Hemophilia
High Blood Pressure
Circulatory Problems
Epilepsy
Thyroid Disturbances
Kidney Disease
Stomach Ulcers
Cancer
Stroke
Prosthetic Hip or Joint
Hepatitis
Keloid Scars
Sensitivity to Cosmetics
Dry Eyes
Alopecia
Watery Eyes
Eyelid Surgery
Trichotillomania
Cold Sores (herpes simplex)
Acutance within 6 months
Fat Injections
Chemical or laser peel within 6 months
Retin A within 6 months
Palpitations
Heart Murmur
Pacemaker
Anemia
Prolonged Bleeding
Low Blood Pressure
Diabetes
Fainting Spells or Dizziness
Liver Disease
Glaucoma
Tumours, Growths or Cysts
Tuberculosis
HIV
Systemic Lupus Erythematosus
Shingles
Bruise or Bleed Easily
Do you tan regularly?
Do you suffer from eye Infections
Ocular Herpes
Do you have Healing Problems
Chapped Lips
Recent Hair Loss
Steroids within 6 months
Dermal Fillers i.e restylane
Botox Enhancement
Asthma
Do your scars heal a darker colour than the rest of your skin?
Fourth Clients's Name

First Name*

Last Name*
Fourth Clients's Date of Birth*
Fourth Clients's Information
Are you over the age of 18?*
No
Yes

Age *
Have you had any alcohol within the last 72 hours before your appointment?*
No
Yes
Have you had any aspirin or blood thinning products within the last 7 days?*
No
Yes

Any mood altering drugs within the last 8 hours (Xanax, Prozac, Wellbutrin) etc... *
Do you take prescription drugs?*
No
Yes
Do you have any history of cold sores, herpes or fever blisters?*
No
Yes
Are you sensitive/allergic to latex?*
No
Yes
Do you have problems with healing? Do you scar easily?*
No
Yes
Do you bleed easily from minor skin injuries?*
No
Yes
Previous problems with tattoos or has your physician advised you not to have a tattoo at this time?*
No
Yes
Are you allergic to any metal? (Can you only wear 14k gold?)*
No
Yes
Have you ever had any permanent makeup procedures before, prior to coming to Studio Sohn?*
No
Yes
Are you allergic to topical antibiotic numbing creams?*
No
Yes

Are you taking any vitamins? *
Are you pregnant or nursing?*
No
Yes
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes

Do you have any drug allergies? If yes, Please print in the space provided below *
Are you currently taking medication for high or low blood pressure?*
No
Yes
Do you intentionally tan-direct sun or tanning bed?*
No
Yes
Have you experienced Hepatitis or Jaundice during the past 12 months?*
No
Yes

If you check off more than 3 of the following questions above, you checking off the box(es) does not indicate you are not an acceptable candidate for permanent cosmetics. It may simply be information that is valuable to your technician as each person's body is unique, or it may indicate that based on health conditions that affects healing, it would be advisable or required for you to consult with your physician before proceeding. If this form has not addressed a medical condition you have, please list it here below.

List all the medications you have been taking in the last 6 months *

Have you taken any of the following in the last 2 days; Aspirin, Ibuprofen, Alcohol? *
Have you received chemotherapy or radiation treatment in the last year?*
No
Yes

Name of Doctor:

List of recent surgery's *
Allergies: have you ever had an allergic reaction to any of the following:
Antibiotic ointments
Medication
Drugs
Paints
Latex Rubber
Metals
Foods
Crayons
Nuts
Hair dyes
Lidocaine
Glycerin
Have you had a dental injection to numb your mouth?*
No
Yes
Do you give blood?*
No
Yes
Prior to dental procedures do you receive antibiotic therapy?*
No
Yes
Please fill out the following table with a check to indicate if any of the following
Abnormal Heart Condition
Mitral Valve Prolapsed
Rheumatic Fever
Artificial Heart Valves
Hemophilia
High Blood Pressure
Circulatory Problems
Epilepsy
Thyroid Disturbances
Kidney Disease
Stomach Ulcers
Cancer
Stroke
Prosthetic Hip or Joint
Hepatitis
Keloid Scars
Sensitivity to Cosmetics
Dry Eyes
Alopecia
Watery Eyes
Eyelid Surgery
Trichotillomania
Cold Sores (herpes simplex)
Acutance within 6 months
Fat Injections
Chemical or laser peel within 6 months
Retin A within 6 months
Palpitations
Heart Murmur
Pacemaker
Anemia
Prolonged Bleeding
Low Blood Pressure
Diabetes
Fainting Spells or Dizziness
Liver Disease
Glaucoma
Tumours, Growths or Cysts
Tuberculosis
HIV
Systemic Lupus Erythematosus
Shingles
Bruise or Bleed Easily
Do you tan regularly?
Do you suffer from eye Infections
Ocular Herpes
Do you have Healing Problems
Chapped Lips
Recent Hair Loss
Steroids within 6 months
Dermal Fillers i.e restylane
Botox Enhancement
Asthma
Do your scars heal a darker colour than the rest of your skin?
Fifth Clients's Name

First Name*

Last Name*
Fifth Clients's Date of Birth*
Fifth Clients's Information
Are you over the age of 18?*
No
Yes

Age *
Have you had any alcohol within the last 72 hours before your appointment?*
No
Yes
Have you had any aspirin or blood thinning products within the last 7 days?*
No
Yes

Any mood altering drugs within the last 8 hours (Xanax, Prozac, Wellbutrin) etc... *
Do you take prescription drugs?*
No
Yes
Do you have any history of cold sores, herpes or fever blisters?*
No
Yes
Are you sensitive/allergic to latex?*
No
Yes
Do you have problems with healing? Do you scar easily?*
No
Yes
Do you bleed easily from minor skin injuries?*
No
Yes
Previous problems with tattoos or has your physician advised you not to have a tattoo at this time?*
No
Yes
Are you allergic to any metal? (Can you only wear 14k gold?)*
No
Yes
Have you ever had any permanent makeup procedures before, prior to coming to Studio Sohn?*
No
Yes
Are you allergic to topical antibiotic numbing creams?*
No
Yes

Are you taking any vitamins? *
Are you pregnant or nursing?*
No
Yes
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes

Do you have any drug allergies? If yes, Please print in the space provided below *
Are you currently taking medication for high or low blood pressure?*
No
Yes
Do you intentionally tan-direct sun or tanning bed?*
No
Yes
Have you experienced Hepatitis or Jaundice during the past 12 months?*
No
Yes

If you check off more than 3 of the following questions above, you checking off the box(es) does not indicate you are not an acceptable candidate for permanent cosmetics. It may simply be information that is valuable to your technician as each person's body is unique, or it may indicate that based on health conditions that affects healing, it would be advisable or required for you to consult with your physician before proceeding. If this form has not addressed a medical condition you have, please list it here below.

List all the medications you have been taking in the last 6 months *

Have you taken any of the following in the last 2 days; Aspirin, Ibuprofen, Alcohol? *
Have you received chemotherapy or radiation treatment in the last year?*
No
Yes

Name of Doctor:

List of recent surgery's *
Allergies: have you ever had an allergic reaction to any of the following:
Antibiotic ointments
Medication
Drugs
Paints
Latex Rubber
Metals
Foods
Crayons
Nuts
Hair dyes
Lidocaine
Glycerin
Have you had a dental injection to numb your mouth?*
No
Yes
Do you give blood?*
No
Yes
Prior to dental procedures do you receive antibiotic therapy?*
No
Yes
Please fill out the following table with a check to indicate if any of the following
Abnormal Heart Condition
Mitral Valve Prolapsed
Rheumatic Fever
Artificial Heart Valves
Hemophilia
High Blood Pressure
Circulatory Problems
Epilepsy
Thyroid Disturbances
Kidney Disease
Stomach Ulcers
Cancer
Stroke
Prosthetic Hip or Joint
Hepatitis
Keloid Scars
Sensitivity to Cosmetics
Dry Eyes
Alopecia
Watery Eyes
Eyelid Surgery
Trichotillomania
Cold Sores (herpes simplex)
Acutance within 6 months
Fat Injections
Chemical or laser peel within 6 months
Retin A within 6 months
Palpitations
Heart Murmur
Pacemaker
Anemia
Prolonged Bleeding
Low Blood Pressure
Diabetes
Fainting Spells or Dizziness
Liver Disease
Glaucoma
Tumours, Growths or Cysts
Tuberculosis
HIV
Systemic Lupus Erythematosus
Shingles
Bruise or Bleed Easily
Do you tan regularly?
Do you suffer from eye Infections
Ocular Herpes
Do you have Healing Problems
Chapped Lips
Recent Hair Loss
Steroids within 6 months
Dermal Fillers i.e restylane
Botox Enhancement
Asthma
Do your scars heal a darker colour than the rest of your skin?
Sixth Clients's Name

First Name*

Last Name*
Sixth Clients's Date of Birth*
Sixth Clients's Information
Are you over the age of 18?*
No
Yes

Age *
Have you had any alcohol within the last 72 hours before your appointment?*
No
Yes
Have you had any aspirin or blood thinning products within the last 7 days?*
No
Yes

Any mood altering drugs within the last 8 hours (Xanax, Prozac, Wellbutrin) etc... *
Do you take prescription drugs?*
No
Yes
Do you have any history of cold sores, herpes or fever blisters?*
No
Yes
Are you sensitive/allergic to latex?*
No
Yes
Do you have problems with healing? Do you scar easily?*
No
Yes
Do you bleed easily from minor skin injuries?*
No
Yes
Previous problems with tattoos or has your physician advised you not to have a tattoo at this time?*
No
Yes
Are you allergic to any metal? (Can you only wear 14k gold?)*
No
Yes
Have you ever had any permanent makeup procedures before, prior to coming to Studio Sohn?*
No
Yes
Are you allergic to topical antibiotic numbing creams?*
No
Yes

Are you taking any vitamins? *
Are you pregnant or nursing?*
No
Yes
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes

Do you have any drug allergies? If yes, Please print in the space provided below *
Are you currently taking medication for high or low blood pressure?*
No
Yes
Do you intentionally tan-direct sun or tanning bed?*
No
Yes
Have you experienced Hepatitis or Jaundice during the past 12 months?*
No
Yes

If you check off more than 3 of the following questions above, you checking off the box(es) does not indicate you are not an acceptable candidate for permanent cosmetics. It may simply be information that is valuable to your technician as each person's body is unique, or it may indicate that based on health conditions that affects healing, it would be advisable or required for you to consult with your physician before proceeding. If this form has not addressed a medical condition you have, please list it here below.

List all the medications you have been taking in the last 6 months *

Have you taken any of the following in the last 2 days; Aspirin, Ibuprofen, Alcohol? *
Have you received chemotherapy or radiation treatment in the last year?*
No
Yes

Name of Doctor:

List of recent surgery's *
Allergies: have you ever had an allergic reaction to any of the following:
Antibiotic ointments
Medication
Drugs
Paints
Latex Rubber
Metals
Foods
Crayons
Nuts
Hair dyes
Lidocaine
Glycerin
Have you had a dental injection to numb your mouth?*
No
Yes
Do you give blood?*
No
Yes
Prior to dental procedures do you receive antibiotic therapy?*
No
Yes
Please fill out the following table with a check to indicate if any of the following
Abnormal Heart Condition
Mitral Valve Prolapsed
Rheumatic Fever
Artificial Heart Valves
Hemophilia
High Blood Pressure
Circulatory Problems
Epilepsy
Thyroid Disturbances
Kidney Disease
Stomach Ulcers
Cancer
Stroke
Prosthetic Hip or Joint
Hepatitis
Keloid Scars
Sensitivity to Cosmetics
Dry Eyes
Alopecia
Watery Eyes
Eyelid Surgery
Trichotillomania
Cold Sores (herpes simplex)
Acutance within 6 months
Fat Injections
Chemical or laser peel within 6 months
Retin A within 6 months
Palpitations
Heart Murmur
Pacemaker
Anemia
Prolonged Bleeding
Low Blood Pressure
Diabetes
Fainting Spells or Dizziness
Liver Disease
Glaucoma
Tumours, Growths or Cysts
Tuberculosis
HIV
Systemic Lupus Erythematosus
Shingles
Bruise or Bleed Easily
Do you tan regularly?
Do you suffer from eye Infections
Ocular Herpes
Do you have Healing Problems
Chapped Lips
Recent Hair Loss
Steroids within 6 months
Dermal Fillers i.e restylane
Botox Enhancement
Asthma
Do your scars heal a darker colour than the rest of your skin?
Seventh Clients's Name

First Name*

Last Name*
Seventh Clients's Date of Birth*
Seventh Clients's Information
Are you over the age of 18?*
No
Yes

Age *
Have you had any alcohol within the last 72 hours before your appointment?*
No
Yes
Have you had any aspirin or blood thinning products within the last 7 days?*
No
Yes

Any mood altering drugs within the last 8 hours (Xanax, Prozac, Wellbutrin) etc... *
Do you take prescription drugs?*
No
Yes
Do you have any history of cold sores, herpes or fever blisters?*
No
Yes
Are you sensitive/allergic to latex?*
No
Yes
Do you have problems with healing? Do you scar easily?*
No
Yes
Do you bleed easily from minor skin injuries?*
No
Yes
Previous problems with tattoos or has your physician advised you not to have a tattoo at this time?*
No
Yes
Are you allergic to any metal? (Can you only wear 14k gold?)*
No
Yes
Have you ever had any permanent makeup procedures before, prior to coming to Studio Sohn?*
No
Yes
Are you allergic to topical antibiotic numbing creams?*
No
Yes

Are you taking any vitamins? *
Are you pregnant or nursing?*
No
Yes
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes

Do you have any drug allergies? If yes, Please print in the space provided below *
Are you currently taking medication for high or low blood pressure?*
No
Yes
Do you intentionally tan-direct sun or tanning bed?*
No
Yes
Have you experienced Hepatitis or Jaundice during the past 12 months?*
No
Yes

If you check off more than 3 of the following questions above, you checking off the box(es) does not indicate you are not an acceptable candidate for permanent cosmetics. It may simply be information that is valuable to your technician as each person's body is unique, or it may indicate that based on health conditions that affects healing, it would be advisable or required for you to consult with your physician before proceeding. If this form has not addressed a medical condition you have, please list it here below.

List all the medications you have been taking in the last 6 months *

Have you taken any of the following in the last 2 days; Aspirin, Ibuprofen, Alcohol? *
Have you received chemotherapy or radiation treatment in the last year?*
No
Yes

Name of Doctor:

List of recent surgery's *
Allergies: have you ever had an allergic reaction to any of the following:
Antibiotic ointments
Medication
Drugs
Paints
Latex Rubber
Metals
Foods
Crayons
Nuts
Hair dyes
Lidocaine
Glycerin
Have you had a dental injection to numb your mouth?*
No
Yes
Do you give blood?*
No
Yes
Prior to dental procedures do you receive antibiotic therapy?*
No
Yes
Please fill out the following table with a check to indicate if any of the following
Abnormal Heart Condition
Mitral Valve Prolapsed
Rheumatic Fever
Artificial Heart Valves
Hemophilia
High Blood Pressure
Circulatory Problems
Epilepsy
Thyroid Disturbances
Kidney Disease
Stomach Ulcers
Cancer
Stroke
Prosthetic Hip or Joint
Hepatitis
Keloid Scars
Sensitivity to Cosmetics
Dry Eyes
Alopecia
Watery Eyes
Eyelid Surgery
Trichotillomania
Cold Sores (herpes simplex)
Acutance within 6 months
Fat Injections
Chemical or laser peel within 6 months
Retin A within 6 months
Palpitations
Heart Murmur
Pacemaker
Anemia
Prolonged Bleeding
Low Blood Pressure
Diabetes
Fainting Spells or Dizziness
Liver Disease
Glaucoma
Tumours, Growths or Cysts
Tuberculosis
HIV
Systemic Lupus Erythematosus
Shingles
Bruise or Bleed Easily
Do you tan regularly?
Do you suffer from eye Infections
Ocular Herpes
Do you have Healing Problems
Chapped Lips
Recent Hair Loss
Steroids within 6 months
Dermal Fillers i.e restylane
Botox Enhancement
Asthma
Do your scars heal a darker colour than the rest of your skin?
Eighth Clients's Name

First Name*

Last Name*
Eighth Clients's Date of Birth*
Eighth Clients's Information
Are you over the age of 18?*
No
Yes

Age *
Have you had any alcohol within the last 72 hours before your appointment?*
No
Yes
Have you had any aspirin or blood thinning products within the last 7 days?*
No
Yes

Any mood altering drugs within the last 8 hours (Xanax, Prozac, Wellbutrin) etc... *
Do you take prescription drugs?*
No
Yes
Do you have any history of cold sores, herpes or fever blisters?*
No
Yes
Are you sensitive/allergic to latex?*
No
Yes
Do you have problems with healing? Do you scar easily?*
No
Yes
Do you bleed easily from minor skin injuries?*
No
Yes
Previous problems with tattoos or has your physician advised you not to have a tattoo at this time?*
No
Yes
Are you allergic to any metal? (Can you only wear 14k gold?)*
No
Yes
Have you ever had any permanent makeup procedures before, prior to coming to Studio Sohn?*
No
Yes
Are you allergic to topical antibiotic numbing creams?*
No
Yes

Are you taking any vitamins? *
Are you pregnant or nursing?*
No
Yes
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes

Do you have any drug allergies? If yes, Please print in the space provided below *
Are you currently taking medication for high or low blood pressure?*
No
Yes
Do you intentionally tan-direct sun or tanning bed?*
No
Yes
Have you experienced Hepatitis or Jaundice during the past 12 months?*
No
Yes

If you check off more than 3 of the following questions above, you checking off the box(es) does not indicate you are not an acceptable candidate for permanent cosmetics. It may simply be information that is valuable to your technician as each person's body is unique, or it may indicate that based on health conditions that affects healing, it would be advisable or required for you to consult with your physician before proceeding. If this form has not addressed a medical condition you have, please list it here below.

List all the medications you have been taking in the last 6 months *

Have you taken any of the following in the last 2 days; Aspirin, Ibuprofen, Alcohol? *
Have you received chemotherapy or radiation treatment in the last year?*
No
Yes

Name of Doctor:

List of recent surgery's *
Allergies: have you ever had an allergic reaction to any of the following:
Antibiotic ointments
Medication
Drugs
Paints
Latex Rubber
Metals
Foods
Crayons
Nuts
Hair dyes
Lidocaine
Glycerin
Have you had a dental injection to numb your mouth?*
No
Yes
Do you give blood?*
No
Yes
Prior to dental procedures do you receive antibiotic therapy?*
No
Yes
Please fill out the following table with a check to indicate if any of the following
Abnormal Heart Condition
Mitral Valve Prolapsed
Rheumatic Fever
Artificial Heart Valves
Hemophilia
High Blood Pressure
Circulatory Problems
Epilepsy
Thyroid Disturbances
Kidney Disease
Stomach Ulcers
Cancer
Stroke
Prosthetic Hip or Joint
Hepatitis
Keloid Scars
Sensitivity to Cosmetics
Dry Eyes
Alopecia
Watery Eyes
Eyelid Surgery
Trichotillomania
Cold Sores (herpes simplex)
Acutance within 6 months
Fat Injections
Chemical or laser peel within 6 months
Retin A within 6 months
Palpitations
Heart Murmur
Pacemaker
Anemia
Prolonged Bleeding
Low Blood Pressure
Diabetes
Fainting Spells or Dizziness
Liver Disease
Glaucoma
Tumours, Growths or Cysts
Tuberculosis
HIV
Systemic Lupus Erythematosus
Shingles
Bruise or Bleed Easily
Do you tan regularly?
Do you suffer from eye Infections
Ocular Herpes
Do you have Healing Problems
Chapped Lips
Recent Hair Loss
Steroids within 6 months
Dermal Fillers i.e restylane
Botox Enhancement
Asthma
Do your scars heal a darker colour than the rest of your skin?
Ninth Clients's Name

First Name*

Last Name*
Ninth Clients's Date of Birth*
Ninth Clients's Information
Are you over the age of 18?*
No
Yes

Age *
Have you had any alcohol within the last 72 hours before your appointment?*
No
Yes
Have you had any aspirin or blood thinning products within the last 7 days?*
No
Yes

Any mood altering drugs within the last 8 hours (Xanax, Prozac, Wellbutrin) etc... *
Do you take prescription drugs?*
No
Yes
Do you have any history of cold sores, herpes or fever blisters?*
No
Yes
Are you sensitive/allergic to latex?*
No
Yes
Do you have problems with healing? Do you scar easily?*
No
Yes
Do you bleed easily from minor skin injuries?*
No
Yes
Previous problems with tattoos or has your physician advised you not to have a tattoo at this time?*
No
Yes
Are you allergic to any metal? (Can you only wear 14k gold?)*
No
Yes
Have you ever had any permanent makeup procedures before, prior to coming to Studio Sohn?*
No
Yes
Are you allergic to topical antibiotic numbing creams?*
No
Yes

Are you taking any vitamins? *
Are you pregnant or nursing?*
No
Yes
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes

Do you have any drug allergies? If yes, Please print in the space provided below *
Are you currently taking medication for high or low blood pressure?*
No
Yes
Do you intentionally tan-direct sun or tanning bed?*
No
Yes
Have you experienced Hepatitis or Jaundice during the past 12 months?*
No
Yes

If you check off more than 3 of the following questions above, you checking off the box(es) does not indicate you are not an acceptable candidate for permanent cosmetics. It may simply be information that is valuable to your technician as each person's body is unique, or it may indicate that based on health conditions that affects healing, it would be advisable or required for you to consult with your physician before proceeding. If this form has not addressed a medical condition you have, please list it here below.

List all the medications you have been taking in the last 6 months *

Have you taken any of the following in the last 2 days; Aspirin, Ibuprofen, Alcohol? *
Have you received chemotherapy or radiation treatment in the last year?*
No
Yes

Name of Doctor:

List of recent surgery's *
Allergies: have you ever had an allergic reaction to any of the following:
Antibiotic ointments
Medication
Drugs
Paints
Latex Rubber
Metals
Foods
Crayons
Nuts
Hair dyes
Lidocaine
Glycerin
Have you had a dental injection to numb your mouth?*
No
Yes
Do you give blood?*
No
Yes
Prior to dental procedures do you receive antibiotic therapy?*
No
Yes
Please fill out the following table with a check to indicate if any of the following
Abnormal Heart Condition
Mitral Valve Prolapsed
Rheumatic Fever
Artificial Heart Valves
Hemophilia
High Blood Pressure
Circulatory Problems
Epilepsy
Thyroid Disturbances
Kidney Disease
Stomach Ulcers
Cancer
Stroke
Prosthetic Hip or Joint
Hepatitis
Keloid Scars
Sensitivity to Cosmetics
Dry Eyes
Alopecia
Watery Eyes
Eyelid Surgery
Trichotillomania
Cold Sores (herpes simplex)
Acutance within 6 months
Fat Injections
Chemical or laser peel within 6 months
Retin A within 6 months
Palpitations
Heart Murmur
Pacemaker
Anemia
Prolonged Bleeding
Low Blood Pressure
Diabetes
Fainting Spells or Dizziness
Liver Disease
Glaucoma
Tumours, Growths or Cysts
Tuberculosis
HIV
Systemic Lupus Erythematosus
Shingles
Bruise or Bleed Easily
Do you tan regularly?
Do you suffer from eye Infections
Ocular Herpes
Do you have Healing Problems
Chapped Lips
Recent Hair Loss
Steroids within 6 months
Dermal Fillers i.e restylane
Botox Enhancement
Asthma
Do your scars heal a darker colour than the rest of your skin?
Tenth Clients's Name

First Name*

Last Name*
Tenth Clients's Date of Birth*
Tenth Clients's Information
Are you over the age of 18?*
No
Yes

Age *
Have you had any alcohol within the last 72 hours before your appointment?*
No
Yes
Have you had any aspirin or blood thinning products within the last 7 days?*
No
Yes

Any mood altering drugs within the last 8 hours (Xanax, Prozac, Wellbutrin) etc... *
Do you take prescription drugs?*
No
Yes
Do you have any history of cold sores, herpes or fever blisters?*
No
Yes
Are you sensitive/allergic to latex?*
No
Yes
Do you have problems with healing? Do you scar easily?*
No
Yes
Do you bleed easily from minor skin injuries?*
No
Yes
Previous problems with tattoos or has your physician advised you not to have a tattoo at this time?*
No
Yes
Are you allergic to any metal? (Can you only wear 14k gold?)*
No
Yes
Have you ever had any permanent makeup procedures before, prior to coming to Studio Sohn?*
No
Yes
Are you allergic to topical antibiotic numbing creams?*
No
Yes

Are you taking any vitamins? *
Are you pregnant or nursing?*
No
Yes
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes

Do you have any drug allergies? If yes, Please print in the space provided below *
Are you currently taking medication for high or low blood pressure?*
No
Yes
Do you intentionally tan-direct sun or tanning bed?*
No
Yes
Have you experienced Hepatitis or Jaundice during the past 12 months?*
No
Yes

If you check off more than 3 of the following questions above, you checking off the box(es) does not indicate you are not an acceptable candidate for permanent cosmetics. It may simply be information that is valuable to your technician as each person's body is unique, or it may indicate that based on health conditions that affects healing, it would be advisable or required for you to consult with your physician before proceeding. If this form has not addressed a medical condition you have, please list it here below.

List all the medications you have been taking in the last 6 months *

Have you taken any of the following in the last 2 days; Aspirin, Ibuprofen, Alcohol? *
Have you received chemotherapy or radiation treatment in the last year?*
No
Yes

Name of Doctor:

List of recent surgery's *
Allergies: have you ever had an allergic reaction to any of the following:
Antibiotic ointments
Medication
Drugs
Paints
Latex Rubber
Metals
Foods
Crayons
Nuts
Hair dyes
Lidocaine
Glycerin
Have you had a dental injection to numb your mouth?*
No
Yes
Do you give blood?*
No
Yes
Prior to dental procedures do you receive antibiotic therapy?*
No
Yes
Please fill out the following table with a check to indicate if any of the following
Abnormal Heart Condition
Mitral Valve Prolapsed
Rheumatic Fever
Artificial Heart Valves
Hemophilia
High Blood Pressure
Circulatory Problems
Epilepsy
Thyroid Disturbances
Kidney Disease
Stomach Ulcers
Cancer
Stroke
Prosthetic Hip or Joint
Hepatitis
Keloid Scars
Sensitivity to Cosmetics
Dry Eyes
Alopecia
Watery Eyes
Eyelid Surgery
Trichotillomania
Cold Sores (herpes simplex)
Acutance within 6 months
Fat Injections
Chemical or laser peel within 6 months
Retin A within 6 months
Palpitations
Heart Murmur
Pacemaker
Anemia
Prolonged Bleeding
Low Blood Pressure
Diabetes
Fainting Spells or Dizziness
Liver Disease
Glaucoma
Tumours, Growths or Cysts
Tuberculosis
HIV
Systemic Lupus Erythematosus
Shingles
Bruise or Bleed Easily
Do you tan regularly?
Do you suffer from eye Infections
Ocular Herpes
Do you have Healing Problems
Chapped Lips
Recent Hair Loss
Steroids within 6 months
Dermal Fillers i.e restylane
Botox Enhancement
Asthma
Do your scars heal a darker colour than the rest of your skin?
Clients's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Card on File

16-digit number *

Expiration date *

Security Code *

Billing Zip Code *
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Emergency Contact's Relation to Participant
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Are you over the age of 18?*
No
Yes

Age *
Have you had any alcohol within the last 72 hours before your appointment?*
No
Yes
Have you had any aspirin or blood thinning products within the last 7 days?*
No
Yes

Any mood altering drugs within the last 8 hours (Xanax, Prozac, Wellbutrin) etc... *
Do you take prescription drugs?*
No
Yes
Do you have any history of cold sores, herpes or fever blisters?*
No
Yes
Are you sensitive/allergic to latex?*
No
Yes
Do you have problems with healing? Do you scar easily?*
No
Yes
Do you bleed easily from minor skin injuries?*
No
Yes
Previous problems with tattoos or has your physician advised you not to have a tattoo at this time?*
No
Yes
Are you allergic to any metal? (Can you only wear 14k gold?)*
No
Yes
Have you ever had any permanent makeup procedures before, prior to coming to Studio Sohn?*
No
Yes
Are you allergic to topical antibiotic numbing creams?*
No
Yes

Are you taking any vitamins? *
Are you pregnant or nursing?*
No
Yes
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes

Do you have any drug allergies? If yes, Please print in the space provided below *
Are you currently taking medication for high or low blood pressure?*
No
Yes
Do you intentionally tan-direct sun or tanning bed?*
No
Yes
Have you experienced Hepatitis or Jaundice during the past 12 months?*
No
Yes

If you check off more than 3 of the following questions above, you checking off the box(es) does not indicate you are not an acceptable candidate for permanent cosmetics. It may simply be information that is valuable to your technician as each person's body is unique, or it may indicate that based on health conditions that affects healing, it would be advisable or required for you to consult with your physician before proceeding. If this form has not addressed a medical condition you have, please list it here below.

List all the medications you have been taking in the last 6 months *

Have you taken any of the following in the last 2 days; Aspirin, Ibuprofen, Alcohol? *
Have you received chemotherapy or radiation treatment in the last year?*
No
Yes

Name of Doctor:

List of recent surgery's *
Allergies: have you ever had an allergic reaction to any of the following:
Antibiotic ointments
Medication
Drugs
Paints
Latex Rubber
Metals
Foods
Crayons
Nuts
Hair dyes
Lidocaine
Glycerin
Have you had a dental injection to numb your mouth?*
No
Yes
Do you give blood?*
No
Yes
Prior to dental procedures do you receive antibiotic therapy?*
No
Yes
Please fill out the following table with a check to indicate if any of the following
Abnormal Heart Condition
Mitral Valve Prolapsed
Rheumatic Fever
Artificial Heart Valves
Hemophilia
High Blood Pressure
Circulatory Problems
Epilepsy
Thyroid Disturbances
Kidney Disease
Stomach Ulcers
Cancer
Stroke
Prosthetic Hip or Joint
Hepatitis
Keloid Scars
Sensitivity to Cosmetics
Dry Eyes
Alopecia
Watery Eyes
Eyelid Surgery
Trichotillomania
Cold Sores (herpes simplex)
Acutance within 6 months
Fat Injections
Chemical or laser peel within 6 months
Retin A within 6 months
Palpitations
Heart Murmur
Pacemaker
Anemia
Prolonged Bleeding
Low Blood Pressure
Diabetes
Fainting Spells or Dizziness
Liver Disease
Glaucoma
Tumours, Growths or Cysts
Tuberculosis
HIV
Systemic Lupus Erythematosus
Shingles
Bruise or Bleed Easily
Do you tan regularly?
Do you suffer from eye Infections
Ocular Herpes
Do you have Healing Problems
Chapped Lips
Recent Hair Loss
Steroids within 6 months
Dermal Fillers i.e restylane
Botox Enhancement
Asthma
Do your scars heal a darker colour than the rest of your skin?
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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