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Thank you for choosing Eyebrows Secret by Isabel Goulart. 

Eyeliner Enhancement Pre Care Instructions

Please make sure you read the following instructions to assure the best results for your procedure.

 

Feel free to wear makeup to your appointment for the before/after pictures.

  • Please do not wear contact lenses during your appointment.
  • You may take tylenol 30 min prior to the procedure to aid in case of any discomfort. 
  • If you have had any type of eye surgery, consult the physician about how long you should wait before having a permanent eyeliner procedure or if you can have tattooing done at all. 
  • If you have used any lash thickening or lash growth serums (Rapid Lash / MD Lash etc) You must wait 1 month before you can get the eyeliner procedure. The lash serum will cause unnecessary bruising, swelling, bleeding and possible pigment migration.
  • Please be aware that I will be working on your eyelids and you need to be able to have them touched without scrunching them tightly or shut. Scrunching them will rusult in not being able to tattoo them properly and will result in additional swelling and/or bruising.
  • For best results you will need to be relaxed throughout the procedure.
  • You cannot have Lash Extension - Lash extensions must be removed 5 days prior to your appointment.
  • It is very important to refrain from all alcohol, aspirin, or aspirin products, such as blood thinners.
  • Please refrain from Ibuprofen and Aleve for 24 hours prior to your appointment.
  • The only product for aches and pain that will not make you bleed is Tylenol.
  • Also refrain from Vitamin E and fish oil capsules for 7 days prior to your application.
  • ALL of these make you bleed excessively. Excessive bleeding during the procedure will negatively affect the longevity of your semi-permanent makeup application. In some cases, the application will need to be prematurely stopped.
  • Please avoid energy drinks & coffee for up to 24 hours prior to your appointment. Not having caffeine in your system will help you to relax much more easily, as well as help to relax the facial muscles in the areas we will be working on. 
  • You may take Arnica 3 days prior to your appointment if you prefer. Arnica may help reduce swelling, decrease pain, and act as an antibiotic.

Thank you again and we look forward to seeing you. 

 

I am over the age of 18, I am not under the influence of drugs or alcohol. I am not pregnant or nursing and desire to receive the indicated permanent cosmetic procedure. The general nature of cosmetic tattooing as well as the specific procedure to be performed has been explained to me. 

Procedure: Eyeliner Enhancement            No. of visits required: 2   

Cost of Procedure:  Top lid only $450.00                Touch-up: $150.00

                                   Lower Lid only $250                Touch-up: $100.00

 

A typical Eyeliner Enhancement appointment lasts 2 to 3 hours. Please keep your smartphone on silent mode. 

I have been informed of the nature, risks, and possible complications or consequences of semi-permanent pigmentation. I understand the semi-permanent skin pigmentation procedure carries with it known and unknown complications and consequences associated with this type of procedure, including but not limited to the following: infections, 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 a form of tattooing and therefore not an exact science, but an art. I request the semi-permanent skin pigmentation procedure(s), and accept the permanence of the procedure as well as the possible complications and consequences of Mircoblading. 

There is a possibility of an allergic reaction to the pigments. A patch test is advisable however, it does not ensure a client will not have an allergic reaction. I consent or waive the patch test. If waived, I release the technician from all liabilities if I develop an allergic reaction to the pigment.

I Agree
 

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. 

I have received both pre and post care procedural instructions and I will strictly adhere to such instructions. I understand that my failure to do so many 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. If I have ever had cold sores, I will consult with and strictly adhere to my doctor’s instructions before contemplating any semi-permanent cosmetic procedure around the lips. 

No Guest Please - Due to the nature of our detailed services, we kindly request that you arrive unaccompanied to your appointment. Please— no friends, spouses, children, and pets allowed.

I understand that taking before and after photographs of the said procedure are a condition of the procedure. I certify that I have read and initialed the above paragraphs and have had explained to me this consent and procedure permit. I accept full responsibility for the decision to have this cosmetic tattoo work done. 

Healed results will vary with each individual client. No guarantees can or will be made. Additional sessions (at a minimum charge) may be required to obtain optimal results. We have the right to refuse any client. Although we give our best efforts to provide you with quality service, many factors can result in a less than desired outcome as each client will heal differently. Please refer to our FAQ section to see if the services we offer may be beneficial to you and whether or not the prep and post care directions are a good fit for your lifestyle. 

 

  October 17, 2021

 

Before and After Photo/Video

I hereby grant Isabel Goulart Studio permission to use my likeness in photographs, video recordings or electronic images in any and all of its publications, including website entries, without payment or any other consideration. I understand and agree that these materials will become the property of the organization and will not be returned.  I hereby irrevocably authorize the organization to edit, alter, copy, exhibit, publish or distribute these images for purposes of publicizing the organization's programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears.  Additionally, I waive any right to royalties or other compensation arising or related to the use of my image. I hereby hold harmless and release and forever discharge the organization from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I am 18 years of age and am competent to contract in my own name, or if I am under age 18, a parent or guardian has signed below. I have read this release before signing below and I fully understand the contents, meaning and impact of this release.

I Agree
   

 

DETAILS ON SMOKING...
IF YOU SMOKE, your results will be compromised to some degree. So stop smoking 
for a couple of weeks, prior to, and for a couple of weeks following the session. Or 
for as long as you can possibly hold out.
WHY? Because the carbon monoxide that has been lovingly added to your cigarettes 
has been proven to impede the healing process, by restricting the oxygen content in 
your blood...  Less oxygen = slower healing time.
Will you heal if you continue to smoke?  Yes. It will just take longer, which will allow 
more pigment to release, rather than heal in.  Will you probably need more followup 
visits? Yes.   

 

First Client Name Name

First Name*

Last Name*

Phone*
First Client Name Date of Birth*
First Client Name Signature*
Second Client Name Name

First Name*

Last Name*

Phone*
Second Client Name Date of Birth*
Third Client Name Name

First Name*

Last Name*

Phone*
Third Client Name Date of Birth*
Fourth Client Name Name

First Name*

Last Name*

Phone*
Fourth Client Name Date of Birth*
Fifth Client Name Name

First Name*

Last Name*

Phone*
Fifth Client Name Date of Birth*
Sixth Client Name Name

First Name*

Last Name*

Phone*
Sixth Client Name Date of Birth*
Seventh Client Name Name

First Name*

Last Name*

Phone*
Seventh Client Name Date of Birth*
Eighth Client Name Name

First Name*

Last Name*

Phone*
Eighth Client Name Date of Birth*
Ninth Client Name Name

First Name*

Last Name*

Phone*
Ninth Client Name Date of Birth*
Tenth Client Name Name

First Name*

Last Name*

Phone*
Tenth Client Name Date of Birth*
Client Name 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*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Confidential Medical Profile
Have you had any alcohol in last 24 Hours?*
No
Yes
Do you have any allergies to latex?*
No
Yes
Do you bruise easily for no abvious reason?*
No
Yes
Do you have any prosthetic implants?*
No
Yes
Do you have any type of herpes?*
No
Yes
Are you sensitive to petrolium based products?*
No
Yes
Are you wearing a pacemaker?*
No
Yes
Are you animic?*
No
Yes
Do you have any medical condition that has resulted in a medical professional requiring you to premedicate with an antibiotic prior to dental or other inasive procedures?*
No
Yes
Do you have allergies to makeup?*
No
Yes
To your knowlege are yo allergic or resistant to over the counter level numbing products such as ELA-Max?*
No
Yes
Do you hyper-pigment? (Tendency to develop dark spots on the skin from wounds or sun)?*
No
Yes
Do you hypo-pigment? (Lack of pigment on the skin)?*
No
Yes
Do you tend to develop keloid or hypertrophy scars?*
No
Yes
Do you have tendency to faint or become dizzy?*
No
Yes

Do you menstruate? if yes, Next cycle date:
Do you have any type of hepatitis?*
No
Yes
Are you allergic to hair dyes?*
No
Yes
Do you bleed exessively from minor cuts?*
No
Yes
Do you have sinus problems?*
No
Yes
Do you have high or low blood pressure?*
No
Yes
Click to customize question*
No
Yes
Are you diabetic? If so,Type 1 or Type 2?*
Do you have autoimune disorders?*
No
Yes
Do you have glaucoma or any other eye disease?*
No
Yes
To avoid unforeseen complications, please answer Y (yes) or N (no) to the following questions:
Do you have previous Permanent Make Up?*
No
Yes

If yes when?
Are you over the age of 18? Legal guardian's initials _______*
No
Yes
Have you had Botox or injectables?*
No
Yes

If yes when?
Have you had Aspirin or any blood thinning medications/supplements within the last 7 days?*
No
Yes
Do you take Antidepressants or mood altering medication?*
No
Yes
Have you had chemical or laser peel?*
No
Yes

If so when?
Do you have any problems with healing?*
No
Yes
Do you get fever blisters or cold sores?*
No
Yes
Are you currently undergoing radiation or chemotherapy?*
No
Yes
Are you currently using Retin-A or Alpha Hydroxyl skin care products?*
No
Yes
Do you wear contact lenses?*
No
Yes
Have you had caffeine products in the last 24 hours?*
No
Yes
Are you taking any medication, including immunosuppressive, such as anti-inflammatory or steroids?*
No
Yes
Are you allergic to topical antibiotic preparation? e.g. Polysporin, Bacitracin, Neosporin, or Caine family of drugs or Petroleum based products (Vaseline)?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Are you presently taking Vitamins A, E or fish oil in any form?*
No
Yes
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any heart conditions?*
No
Yes
Do you have Alopecia?*
No
Yes
Are you currently on Accutane Treatment?*
No
Yes
Do you have Keloid or Hypertrophy Scars?*
No
Yes
Do you have Hepatitis?*
No
Yes
Do you have Diabetes?*
No
Yes
Any tendency to bleed excessively from minor cuts?*
No
Yes
Do you have Epilepsy/ Seizures of any kind?*
No
Yes
Do you have any Autoimmune Disorders?*
No
Yes
Do you currently or have you had Cancer?*
No
Yes

If yes, please explain.

Do you have HIV?*
No
Yes

Please list any other medical conditions, and list all.

Doctor's Name and Number
I acknowledge that it is not reasonably possible to determine whether I might have an allergic reaction to any of the pigments, dyes, topical preparations , or processes used in the procedure; and I agree to accept the risks that such a reaction although rare, is possible. I have informed Isabel Goulart of any existing problems.*
No
Yes
I acknowledge that hyper-pigmentation (darkening of the skin) or hypo-pigmentation (absence of color in the skin), or scarring is a possibility as a result of my body's reaction to the skin being broken during the procedure. I realize that my body is unique and that Isabel Goulart cannot predict how my body will react as a result of this procedure.*
No
Yes
I acknowledge that the procedure(s) will result in a permanent change to my appearance and that no representations have been made to me as to the ability to later change or remove the results. Tattoo removal is a surgical procedure which may cause scarring and/or disfigurement.*
No
Yes
Alopecia clients- due to the change in skinn texture, may require more frequent touch-ups, and in some cases, the pigment will not retain.*
No
Yes
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.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
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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