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Permanent Makeup Informed Consent.

All information is collected by Ivonne Sanchez Beauty pursuant to O. Reg. 136/18: PERSONAL SERVICE SETTINGS and The Personal Information Protection and Electronic Documents Act (“PIPEDA “).

Terminology


The words “I”, “you” and “your" are used interchangeably throughout this agreement and in all cases refer to you the client who is receiving the treatment or procedure.

“Practitioner”, “technician”, “instructor” and “we” means 10981508 CANADA INC. (“Ivonne Sanchez Beauty”), its staff or contractors.

Permanent Makeup Informed Consent

No guarantee can be given to me as to the condition of my skin or degree of improvement expected following my procedure(s).

I understand that there are no refunds.

I understand that I must follow the provided aftercare instructions given to me by my technician and that I must always wash my hands before touching the treated area. (If applicable)

I Agree

If outdoors, I will apply broad spectrum sunscreen with SPF-30 or higher, 30 minutes prior to sun exposure and wear daily until all areas treated have healed and after the treated areas have healed 100% or 3-6 months. 

I Agree

I agree that I will not go on a sun vacation within 30 days of receiving my permanent makeup service, and that if I do this voids any assurances that may have been provided to me. A sun vacation will almost certainly ruin the results of permanet makeup. I will not be eligible for a touch-up or correction if I have been in the tropical sun. 

I Agree

I understand that should any other artist or beauty professional work on my Eyebrows/Lips/Eyeliner or Skin that this will void any expected results and the process may need to start over again. 

I Agree

In rare cases, allergies or sensitivities have been reported in products used during treatments (topical numbing).

I understand that the following 11 items are contraindications (conditions) that may disqualify me as a candidate for permanent makeup procedures:

  1. Infected skin disorder, open cuts, wounds, abrasions
  2. Patients with cardiovascular disease must have doctor’s consent
  3. A pacemaker is a direct contra-indication
  4. Highly anxious patient
  5. Epileptic – electrical currents may precipitate an attack
  6. Pregnancy – electrical currents may precipitate labor
  7. Sunburned or irritated skin
  8. Untreated sinusitis – can cause pain in sinus area
  9. Numb area without sensation
  10. Diabetes – a separate consent from physician may be required
  11. If currently taking blood thinners
  12. I am not a candidate for any permanent makeup appointment if I have received or am scheduled to receive Botox or other filler injections within 2 weeks prior or 2 weeks after my PMU appointment. There must be at least 2 weeks between your injectible services and your PMU service.

I understand that the following possible side effects and/or risk could occur:

As per per page 85 of the Guide to Infection Prevention and Control in Personal Service Settings guide it cites “Infection risk: Tattooing induces physical damage to the skin, which may cause or promote infections if microorganisms are introduced under the skin during the process. The potential sources of microorganisms include:

• Tap water used to dilute the ink. (Note: Ivonne Sanchez Beauty does not use tap water to dilute its pigments and instead uses steril dilution fluids).
• Contaminated and/or improperly reprocessed equipment or ink (Ivonne Sanchez Beauty adheres to sanitation protocols and does not reprocess single-use products)
• Client’s own bacteria on the skin.
• Unclean hands touching the treatment area.

Potential infections can be caused by bacteria (e.g., Mycobacterium spp. or Staphylococcus aureus), fungi (e.g., Candida endophthalmitis), or even viruses (e.g., human immunodeficiency virus [HIV], hepatitis B virus, hepatitis C virus)”

Most people heal without any problem.  However, here are some problems that you may encounter; If you are prone to fever blisters (herpes simplex) then it is recommended to get a prescription for an anti-viral such as:  Zovirax, Acyclovir, or equivalent to take prior to your treatment. This is REQUIRED.

If the skin becomes painful and increasingly red, then you may have developed an infection and you must consult your physician immediately.

In most cases, redness will begin to subside within 2-4 days, some cases may take longer if a more aggressive treatment is performed. Pinkness may take up to one month to fade. This is not uncommon.

Do keep the treated areas clean.  You can wash with a gentle cleanser as often as needed then re-apply moisturizer. Avoid retinols for 10 days after the procedure.

I understand that the treated area can remain pink for up to 1 month or sometimes longer and will gradually lighten with time. (Each client will heal differently).

AVOID EXPOSURE TO DIRECT SUNLIGHT UNTIL THE AREAS HAVE COMPLETELY HEALED. (3-6 months)    

I have read and understand the contents of this consent.

Addendum to Consent.
Tan Skin

I understand that having tan skin at the time of the appointment is a contraindication in permanent makeup.  Tan skin will bleed, possibly heal darker and can or will fade to an ashy colour as the tan fades.  The pigment CAN and WILL heal more “solid” or “powdered”.  The hair strokes can look thicker, appear blurry under the skin, change in colour, fade prematurely or not retain at all.   These are all potential risks that I accept may or may not happen.

NO guarantees have been made to me as to the final results.

I fully understand and accept the above-mentioned risks and will hold Ivonne Sanchez (Ivonne Sanchez) harmless if mentioned risks do occur.  I understand that appointments will not be made any sooner if the above-mentioned risks occur and there may be a chance that any future procedures may not be performed.  This is left up to the discretion of Ivonne.

Against Ivonne’s recommendation, I wish to proceed.

Addendum to Consent.
Oily to Severely Oily Skin and Large Pores

I understand that having oily/severely oily skin or large pores are contraindications in permanent makeup.  Due to the over-production of the oil glands in the skin and the size of the pores, the pigment CAN and WILL heal more “solid” or “powdered” looking.  The hair strokes can look thicker, appear blurry under the skin, change in colour, fade prematurely or not retain at all.   These are all potential risks that I accept may or can happen. 

NO guarantees have been made to me as to the final results.

I fully understand and accept the aforementioned risks and will not hold Ivonne Sanchez (Ivonne Sanchez) accountable if the aforementioned risks or outcomes occur.

Against Ivonne’s recommendation I wish to proceed anyway with microblading and or micro-shading. 

I understand that appointments will not be made any sooner if the above risks occur and there may be a chance that any future procedures may not be performed.  Any decision is left to Ivonne’s discretion.

BB Glow Informed Consent

I understand that BB Glow service is a cosmetic service and NOT a therapeutic service like microneedling. I understand that BB Glow is a process that involves applying permanent blush pigments into the outermost layer of the skin (epidermis) and is intended to last for only several weeks or up to several months depending on the number of applications. BB Glow is first and foremost a pigmentation process and while it covers up blemishes and provides an even tone it is not meant to resolve any underlying skin concerns.

Cancellation Policy and Reminders.

All bookings are recorded in an online booking system. This system will send an e-mail confirmation to you of your scheduled appointment at the time that the scheduling is made. The booking system will also send a follow-up reminder e-mail 24 hours prior to your scheduled appointment. Unfortunately, we do not have a telephone reminder service.

A $100 deposit is required in order to make a booking for services. This will be applied to your scheduled service subject to the cancellation policy.

All cancellations and appointment rescheduling requests must be made at least 48 hours prior to the start of your scheduled appointment time.

The following events will result in the loss of the $100 booking deposit and/or 100% charge of service:

  1. No-shows;
  2. Cancellations without a minimum of 48 hours notice; or
  3. Cancellations with 48 hours notice but where a new booking is not made

*When you cancel your appointment without sufficient notice this impacts 3 people:

  1. You, as you then miss out on your scheduled service that you were so looking forward to;
  2. Me, as I lose out on half a day of work doing what I love; and
  3. My other clients who otherwise would have made a booking for the time you did not use

I understand and agree to the above cancellation policy.

Customer Satisfaction and Feedback.

If I am unhappy with the results or service, I will not take to the internet to air my grievances of Ivonne Sanchez, Ivonne Sanchez Beauty in any online forum including but not limited to: Google Reviews, Facebook Reviews, Instagram, Facebook, or Twitter. I will instead contact Ivonne privately in order to allow her to work with me to find a solution.

Today's Date: July 3, 2020

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Age

How you found us:
Area(s) Treated / Treatment Procedure (Please Check):
Eyebrows
Lips
Eyeliner
Other

If other:

Health Questionnaire Part 1.

To help avoid unforeseen complications, please answer the following questions:

Are you over the age of 18? (You must be 18 years of age to receive our services).*
No
Yes
Have you had any aspirin or blood thinning products within the last 7 days?*
No
Yes
Have you taken any mood-altering drugs within the last 8 hours? (e.g. Xanax)*
No
Yes
Do you have any history of cold sores, herpes, or fever blisters?*
No
Yes
Are you sensitive to Latex or Nitrile?*
No
Yes
Have you had a chemical or laser peel?*
No
Yes
Do you have problems with healing?*
No
Yes
Have you had previous problems with tattoos or has your physician advised you not to have a tattoo at this time?*
No
Yes
Are you currently undergoing radiation or chemotherapy?*
No
Yes
Are you currently taking any chemotherapy medications?*
No
Yes
Are you currently using Retin-A or "Alpha Hydroxy" skin care products? (If so, avoid use for 1 month following procedure)*
No
Yes
Do you wear contact lenses?*
No
Yes
Are you allergic to any metal? (e.g. Can you only wear 14k gold):*
No
Yes
Have you ever had any permanent makeup procedures prior to this appointment with Ivonne?*
No
Yes

If "yes" when?:
Are you taking medication, including immunosuppressive, such as anti-inflammatory or steroids?*
No
Yes
Are you in withdrawal from caffeine products?*
No
Yes
Are you allergic to topical antibiotic numbing creams or desensitizers?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you*
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes
Are you currently taking medication for high or low blood pressure?*
No
Yes
Will you work out on the day of treatment?*
No
Yes

No. of times you work out weekly
Have you consumed alcohol on the date of treatment?*
No
Yes

Health Questionnaire Part 2.

Do you have now, or previously had any of the following:
Tuberculosis
Heart issue/Pace Maker
Trichotillomania
Allergies to makeup
Accutane treatment
Dry eyes
Keloids
Thyroid Issues/Meds
Diabetes (type 1)
Stroke/Paralysis
Chest pains
Shortness of breath
Alopecia
Epilepsy/seizure
Smoker
Cataract surgery
Tear duct plugs
Planning on having Facial Plastic Surgery
Cancer (List below)
Tan Regularly
Organ transplant
Vitiligo
Scar(s) in area to be done?
Botox
Other Medical Conditions/Surgeries (list below)
MRSA/Staph
Bleeding Disorder
Eczema/Dermatitis
Hepatitis/Jaundice/HIV
Kidney Disease
Cold sores
Glaucoma
Body runs hot
Hyper-pigmentation
Hypo-pigmentation
Herpes Simplex
Refractive eye surgery
Autoimmune disorders
Shingles (on face)
Eyelid surgery
Lasik surgery
Ocular Herpes
Head Injury/Trauma
Forehead/Brow Lift
Rosacea (on the face)
Lash/Brow Growth Serum
Oily/Combination-Severe Oily skin

Planning on having Facial Plastic Surgery
 Date surgery scheduled:

Botox (date of last treatment)

Please explain any question marked "YES", list any other medical conditions or allergies, and list all your medications:

Consent to be Photographed.

I consent to the reproduction and use of my photo(s) (without identifying client name or identifying marks) with this consent. Consent is for the use of any photograph including but not limited to the use of my photos for any educational purposes, including instruction, display to professional organizations, websites, social media and marketing/advertising thereof.

This consent, as stated above, shall be a continuing consent for all procedures, past, present and future.  Written notice must be received from me the client asking to discontinue use. (60 days written notice is required).

I give Ivonne Sanchez or Ivonne Sanchez permission to use my photo(s) as checked below:
Full Face
Eyebrows with Eyes Only
Lips
Eyes

What is the date of service: *

What is the procedure being performed: *

What is the cost of the service? *

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Age

How you found us:
Area(s) Treated / Treatment Procedure (Please Check):
Eyebrows
Lips
Eyeliner
Other

If other:

Health Questionnaire Part 1.

To help avoid unforeseen complications, please answer the following questions:

Are you over the age of 18? (You must be 18 years of age to receive our services).*
No
Yes
Have you had any aspirin or blood thinning products within the last 7 days?*
No
Yes
Have you taken any mood-altering drugs within the last 8 hours? (e.g. Xanax)*
No
Yes
Do you have any history of cold sores, herpes, or fever blisters?*
No
Yes
Are you sensitive to Latex or Nitrile?*
No
Yes
Have you had a chemical or laser peel?*
No
Yes
Do you have problems with healing?*
No
Yes
Have you had previous problems with tattoos or has your physician advised you not to have a tattoo at this time?*
No
Yes
Are you currently undergoing radiation or chemotherapy?*
No
Yes
Are you currently taking any chemotherapy medications?*
No
Yes
Are you currently using Retin-A or "Alpha Hydroxy" skin care products? (If so, avoid use for 1 month following procedure)*
No
Yes
Do you wear contact lenses?*
No
Yes
Are you allergic to any metal? (e.g. Can you only wear 14k gold):*
No
Yes
Have you ever had any permanent makeup procedures prior to this appointment with Ivonne?*
No
Yes

If "yes" when?:
Are you taking medication, including immunosuppressive, such as anti-inflammatory or steroids?*
No
Yes
Are you in withdrawal from caffeine products?*
No
Yes
Are you allergic to topical antibiotic numbing creams or desensitizers?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you*
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes
Are you currently taking medication for high or low blood pressure?*
No
Yes
Will you work out on the day of treatment?*
No
Yes

No. of times you work out weekly
Have you consumed alcohol on the date of treatment?*
No
Yes

Health Questionnaire Part 2.

Do you have now, or previously had any of the following:
Tuberculosis
Heart issue/Pace Maker
Trichotillomania
Allergies to makeup
Accutane treatment
Dry eyes
Keloids
Thyroid Issues/Meds
Diabetes (type 1)
Stroke/Paralysis
Chest pains
Shortness of breath
Alopecia
Epilepsy/seizure
Smoker
Cataract surgery
Tear duct plugs
Planning on having Facial Plastic Surgery
Cancer (List below)
Tan Regularly
Organ transplant
Vitiligo
Scar(s) in area to be done?
Botox
Other Medical Conditions/Surgeries (list below)
MRSA/Staph
Bleeding Disorder
Eczema/Dermatitis
Hepatitis/Jaundice/HIV
Kidney Disease
Cold sores
Glaucoma
Body runs hot
Hyper-pigmentation
Hypo-pigmentation
Herpes Simplex
Refractive eye surgery
Autoimmune disorders
Shingles (on face)
Eyelid surgery
Lasik surgery
Ocular Herpes
Head Injury/Trauma
Forehead/Brow Lift
Rosacea (on the face)
Lash/Brow Growth Serum
Oily/Combination-Severe Oily skin

Planning on having Facial Plastic Surgery
 Date surgery scheduled:

Botox (date of last treatment)

Please explain any question marked "YES", list any other medical conditions or allergies, and list all your medications:

Consent to be Photographed.

I consent to the reproduction and use of my photo(s) (without identifying client name or identifying marks) with this consent. Consent is for the use of any photograph including but not limited to the use of my photos for any educational purposes, including instruction, display to professional organizations, websites, social media and marketing/advertising thereof.

This consent, as stated above, shall be a continuing consent for all procedures, past, present and future.  Written notice must be received from me the client asking to discontinue use. (60 days written notice is required).

I give Ivonne Sanchez or Ivonne Sanchez permission to use my photo(s) as checked below:
Full Face
Eyebrows with Eyes Only
Lips
Eyes

What is the date of service: *

What is the procedure being performed: *

What is the cost of the service? *

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Age

How you found us:
Area(s) Treated / Treatment Procedure (Please Check):
Eyebrows
Lips
Eyeliner
Other

If other:

Health Questionnaire Part 1.

To help avoid unforeseen complications, please answer the following questions:

Are you over the age of 18? (You must be 18 years of age to receive our services).*
No
Yes
Have you had any aspirin or blood thinning products within the last 7 days?*
No
Yes
Have you taken any mood-altering drugs within the last 8 hours? (e.g. Xanax)*
No
Yes
Do you have any history of cold sores, herpes, or fever blisters?*
No
Yes
Are you sensitive to Latex or Nitrile?*
No
Yes
Have you had a chemical or laser peel?*
No
Yes
Do you have problems with healing?*
No
Yes
Have you had previous problems with tattoos or has your physician advised you not to have a tattoo at this time?*
No
Yes
Are you currently undergoing radiation or chemotherapy?*
No
Yes
Are you currently taking any chemotherapy medications?*
No
Yes
Are you currently using Retin-A or "Alpha Hydroxy" skin care products? (If so, avoid use for 1 month following procedure)*
No
Yes
Do you wear contact lenses?*
No
Yes
Are you allergic to any metal? (e.g. Can you only wear 14k gold):*
No
Yes
Have you ever had any permanent makeup procedures prior to this appointment with Ivonne?*
No
Yes

If "yes" when?:
Are you taking medication, including immunosuppressive, such as anti-inflammatory or steroids?*
No
Yes
Are you in withdrawal from caffeine products?*
No
Yes
Are you allergic to topical antibiotic numbing creams or desensitizers?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you*
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes
Are you currently taking medication for high or low blood pressure?*
No
Yes
Will you work out on the day of treatment?*
No
Yes

No. of times you work out weekly
Have you consumed alcohol on the date of treatment?*
No
Yes

Health Questionnaire Part 2.

Do you have now, or previously had any of the following:
Tuberculosis
Heart issue/Pace Maker
Trichotillomania
Allergies to makeup
Accutane treatment
Dry eyes
Keloids
Thyroid Issues/Meds
Diabetes (type 1)
Stroke/Paralysis
Chest pains
Shortness of breath
Alopecia
Epilepsy/seizure
Smoker
Cataract surgery
Tear duct plugs
Planning on having Facial Plastic Surgery
Cancer (List below)
Tan Regularly
Organ transplant
Vitiligo
Scar(s) in area to be done?
Botox
Other Medical Conditions/Surgeries (list below)
MRSA/Staph
Bleeding Disorder
Eczema/Dermatitis
Hepatitis/Jaundice/HIV
Kidney Disease
Cold sores
Glaucoma
Body runs hot
Hyper-pigmentation
Hypo-pigmentation
Herpes Simplex
Refractive eye surgery
Autoimmune disorders
Shingles (on face)
Eyelid surgery
Lasik surgery
Ocular Herpes
Head Injury/Trauma
Forehead/Brow Lift
Rosacea (on the face)
Lash/Brow Growth Serum
Oily/Combination-Severe Oily skin

Planning on having Facial Plastic Surgery
 Date surgery scheduled:

Botox (date of last treatment)

Please explain any question marked "YES", list any other medical conditions or allergies, and list all your medications:

Consent to be Photographed.

I consent to the reproduction and use of my photo(s) (without identifying client name or identifying marks) with this consent. Consent is for the use of any photograph including but not limited to the use of my photos for any educational purposes, including instruction, display to professional organizations, websites, social media and marketing/advertising thereof.

This consent, as stated above, shall be a continuing consent for all procedures, past, present and future.  Written notice must be received from me the client asking to discontinue use. (60 days written notice is required).

I give Ivonne Sanchez or Ivonne Sanchez permission to use my photo(s) as checked below:
Full Face
Eyebrows with Eyes Only
Lips
Eyes

What is the date of service: *

What is the procedure being performed: *

What is the cost of the service? *

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Age

How you found us:
Area(s) Treated / Treatment Procedure (Please Check):
Eyebrows
Lips
Eyeliner
Other

If other:

Health Questionnaire Part 1.

To help avoid unforeseen complications, please answer the following questions:

Are you over the age of 18? (You must be 18 years of age to receive our services).*
No
Yes
Have you had any aspirin or blood thinning products within the last 7 days?*
No
Yes
Have you taken any mood-altering drugs within the last 8 hours? (e.g. Xanax)*
No
Yes
Do you have any history of cold sores, herpes, or fever blisters?*
No
Yes
Are you sensitive to Latex or Nitrile?*
No
Yes
Have you had a chemical or laser peel?*
No
Yes
Do you have problems with healing?*
No
Yes
Have you had previous problems with tattoos or has your physician advised you not to have a tattoo at this time?*
No
Yes
Are you currently undergoing radiation or chemotherapy?*
No
Yes
Are you currently taking any chemotherapy medications?*
No
Yes
Are you currently using Retin-A or "Alpha Hydroxy" skin care products? (If so, avoid use for 1 month following procedure)*
No
Yes
Do you wear contact lenses?*
No
Yes
Are you allergic to any metal? (e.g. Can you only wear 14k gold):*
No
Yes
Have you ever had any permanent makeup procedures prior to this appointment with Ivonne?*
No
Yes

If "yes" when?:
Are you taking medication, including immunosuppressive, such as anti-inflammatory or steroids?*
No
Yes
Are you in withdrawal from caffeine products?*
No
Yes
Are you allergic to topical antibiotic numbing creams or desensitizers?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you*
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes
Are you currently taking medication for high or low blood pressure?*
No
Yes
Will you work out on the day of treatment?*
No
Yes

No. of times you work out weekly
Have you consumed alcohol on the date of treatment?*
No
Yes

Health Questionnaire Part 2.

Do you have now, or previously had any of the following:
Tuberculosis
Heart issue/Pace Maker
Trichotillomania
Allergies to makeup
Accutane treatment
Dry eyes
Keloids
Thyroid Issues/Meds
Diabetes (type 1)
Stroke/Paralysis
Chest pains
Shortness of breath
Alopecia
Epilepsy/seizure
Smoker
Cataract surgery
Tear duct plugs
Planning on having Facial Plastic Surgery
Cancer (List below)
Tan Regularly
Organ transplant
Vitiligo
Scar(s) in area to be done?
Botox
Other Medical Conditions/Surgeries (list below)
MRSA/Staph
Bleeding Disorder
Eczema/Dermatitis
Hepatitis/Jaundice/HIV
Kidney Disease
Cold sores
Glaucoma
Body runs hot
Hyper-pigmentation
Hypo-pigmentation
Herpes Simplex
Refractive eye surgery
Autoimmune disorders
Shingles (on face)
Eyelid surgery
Lasik surgery
Ocular Herpes
Head Injury/Trauma
Forehead/Brow Lift
Rosacea (on the face)
Lash/Brow Growth Serum
Oily/Combination-Severe Oily skin

Planning on having Facial Plastic Surgery
 Date surgery scheduled:

Botox (date of last treatment)

Please explain any question marked "YES", list any other medical conditions or allergies, and list all your medications:

Consent to be Photographed.

I consent to the reproduction and use of my photo(s) (without identifying client name or identifying marks) with this consent. Consent is for the use of any photograph including but not limited to the use of my photos for any educational purposes, including instruction, display to professional organizations, websites, social media and marketing/advertising thereof.

This consent, as stated above, shall be a continuing consent for all procedures, past, present and future.  Written notice must be received from me the client asking to discontinue use. (60 days written notice is required).

I give Ivonne Sanchez or Ivonne Sanchez permission to use my photo(s) as checked below:
Full Face
Eyebrows with Eyes Only
Lips
Eyes

What is the date of service: *

What is the procedure being performed: *

What is the cost of the service? *

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Age

How you found us:
Area(s) Treated / Treatment Procedure (Please Check):
Eyebrows
Lips
Eyeliner
Other

If other:

Health Questionnaire Part 1.

To help avoid unforeseen complications, please answer the following questions:

Are you over the age of 18? (You must be 18 years of age to receive our services).*
No
Yes
Have you had any aspirin or blood thinning products within the last 7 days?*
No
Yes
Have you taken any mood-altering drugs within the last 8 hours? (e.g. Xanax)*
No
Yes
Do you have any history of cold sores, herpes, or fever blisters?*
No
Yes
Are you sensitive to Latex or Nitrile?*
No
Yes
Have you had a chemical or laser peel?*
No
Yes
Do you have problems with healing?*
No
Yes
Have you had previous problems with tattoos or has your physician advised you not to have a tattoo at this time?*
No
Yes
Are you currently undergoing radiation or chemotherapy?*
No
Yes
Are you currently taking any chemotherapy medications?*
No
Yes
Are you currently using Retin-A or "Alpha Hydroxy" skin care products? (If so, avoid use for 1 month following procedure)*
No
Yes
Do you wear contact lenses?*
No
Yes
Are you allergic to any metal? (e.g. Can you only wear 14k gold):*
No
Yes
Have you ever had any permanent makeup procedures prior to this appointment with Ivonne?*
No
Yes

If "yes" when?:
Are you taking medication, including immunosuppressive, such as anti-inflammatory or steroids?*
No
Yes
Are you in withdrawal from caffeine products?*
No
Yes
Are you allergic to topical antibiotic numbing creams or desensitizers?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you*
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes
Are you currently taking medication for high or low blood pressure?*
No
Yes
Will you work out on the day of treatment?*
No
Yes

No. of times you work out weekly
Have you consumed alcohol on the date of treatment?*
No
Yes

Health Questionnaire Part 2.

Do you have now, or previously had any of the following:
Tuberculosis
Heart issue/Pace Maker
Trichotillomania
Allergies to makeup
Accutane treatment
Dry eyes
Keloids
Thyroid Issues/Meds
Diabetes (type 1)
Stroke/Paralysis
Chest pains
Shortness of breath
Alopecia
Epilepsy/seizure
Smoker
Cataract surgery
Tear duct plugs
Planning on having Facial Plastic Surgery
Cancer (List below)
Tan Regularly
Organ transplant
Vitiligo
Scar(s) in area to be done?
Botox
Other Medical Conditions/Surgeries (list below)
MRSA/Staph
Bleeding Disorder
Eczema/Dermatitis
Hepatitis/Jaundice/HIV
Kidney Disease
Cold sores
Glaucoma
Body runs hot
Hyper-pigmentation
Hypo-pigmentation
Herpes Simplex
Refractive eye surgery
Autoimmune disorders
Shingles (on face)
Eyelid surgery
Lasik surgery
Ocular Herpes
Head Injury/Trauma
Forehead/Brow Lift
Rosacea (on the face)
Lash/Brow Growth Serum
Oily/Combination-Severe Oily skin

Planning on having Facial Plastic Surgery
 Date surgery scheduled:

Botox (date of last treatment)

Please explain any question marked "YES", list any other medical conditions or allergies, and list all your medications:

Consent to be Photographed.

I consent to the reproduction and use of my photo(s) (without identifying client name or identifying marks) with this consent. Consent is for the use of any photograph including but not limited to the use of my photos for any educational purposes, including instruction, display to professional organizations, websites, social media and marketing/advertising thereof.

This consent, as stated above, shall be a continuing consent for all procedures, past, present and future.  Written notice must be received from me the client asking to discontinue use. (60 days written notice is required).

I give Ivonne Sanchez or Ivonne Sanchez permission to use my photo(s) as checked below:
Full Face
Eyebrows with Eyes Only
Lips
Eyes

What is the date of service: *

What is the procedure being performed: *

What is the cost of the service? *

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Age

How you found us:
Area(s) Treated / Treatment Procedure (Please Check):
Eyebrows
Lips
Eyeliner
Other

If other:

Health Questionnaire Part 1.

To help avoid unforeseen complications, please answer the following questions:

Are you over the age of 18? (You must be 18 years of age to receive our services).*
No
Yes
Have you had any aspirin or blood thinning products within the last 7 days?*
No
Yes
Have you taken any mood-altering drugs within the last 8 hours? (e.g. Xanax)*
No
Yes
Do you have any history of cold sores, herpes, or fever blisters?*
No
Yes
Are you sensitive to Latex or Nitrile?*
No
Yes
Have you had a chemical or laser peel?*
No
Yes
Do you have problems with healing?*
No
Yes
Have you had previous problems with tattoos or has your physician advised you not to have a tattoo at this time?*
No
Yes
Are you currently undergoing radiation or chemotherapy?*
No
Yes
Are you currently taking any chemotherapy medications?*
No
Yes
Are you currently using Retin-A or "Alpha Hydroxy" skin care products? (If so, avoid use for 1 month following procedure)*
No
Yes
Do you wear contact lenses?*
No
Yes
Are you allergic to any metal? (e.g. Can you only wear 14k gold):*
No
Yes
Have you ever had any permanent makeup procedures prior to this appointment with Ivonne?*
No
Yes

If "yes" when?:
Are you taking medication, including immunosuppressive, such as anti-inflammatory or steroids?*
No
Yes
Are you in withdrawal from caffeine products?*
No
Yes
Are you allergic to topical antibiotic numbing creams or desensitizers?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you*
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes
Are you currently taking medication for high or low blood pressure?*
No
Yes
Will you work out on the day of treatment?*
No
Yes

No. of times you work out weekly
Have you consumed alcohol on the date of treatment?*
No
Yes

Health Questionnaire Part 2.

Do you have now, or previously had any of the following:
Tuberculosis
Heart issue/Pace Maker
Trichotillomania
Allergies to makeup
Accutane treatment
Dry eyes
Keloids
Thyroid Issues/Meds
Diabetes (type 1)
Stroke/Paralysis
Chest pains
Shortness of breath
Alopecia
Epilepsy/seizure
Smoker
Cataract surgery
Tear duct plugs
Planning on having Facial Plastic Surgery
Cancer (List below)
Tan Regularly
Organ transplant
Vitiligo
Scar(s) in area to be done?
Botox
Other Medical Conditions/Surgeries (list below)
MRSA/Staph
Bleeding Disorder
Eczema/Dermatitis
Hepatitis/Jaundice/HIV
Kidney Disease
Cold sores
Glaucoma
Body runs hot
Hyper-pigmentation
Hypo-pigmentation
Herpes Simplex
Refractive eye surgery
Autoimmune disorders
Shingles (on face)
Eyelid surgery
Lasik surgery
Ocular Herpes
Head Injury/Trauma
Forehead/Brow Lift
Rosacea (on the face)
Lash/Brow Growth Serum
Oily/Combination-Severe Oily skin

Planning on having Facial Plastic Surgery
 Date surgery scheduled:

Botox (date of last treatment)

Please explain any question marked "YES", list any other medical conditions or allergies, and list all your medications:

Consent to be Photographed.

I consent to the reproduction and use of my photo(s) (without identifying client name or identifying marks) with this consent. Consent is for the use of any photograph including but not limited to the use of my photos for any educational purposes, including instruction, display to professional organizations, websites, social media and marketing/advertising thereof.

This consent, as stated above, shall be a continuing consent for all procedures, past, present and future.  Written notice must be received from me the client asking to discontinue use. (60 days written notice is required).

I give Ivonne Sanchez or Ivonne Sanchez permission to use my photo(s) as checked below:
Full Face
Eyebrows with Eyes Only
Lips
Eyes

What is the date of service: *

What is the procedure being performed: *

What is the cost of the service? *

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Age

How you found us:
Area(s) Treated / Treatment Procedure (Please Check):
Eyebrows
Lips
Eyeliner
Other

If other:

Health Questionnaire Part 1.

To help avoid unforeseen complications, please answer the following questions:

Are you over the age of 18? (You must be 18 years of age to receive our services).*
No
Yes
Have you had any aspirin or blood thinning products within the last 7 days?*
No
Yes
Have you taken any mood-altering drugs within the last 8 hours? (e.g. Xanax)*
No
Yes
Do you have any history of cold sores, herpes, or fever blisters?*
No
Yes
Are you sensitive to Latex or Nitrile?*
No
Yes
Have you had a chemical or laser peel?*
No
Yes
Do you have problems with healing?*
No
Yes
Have you had previous problems with tattoos or has your physician advised you not to have a tattoo at this time?*
No
Yes
Are you currently undergoing radiation or chemotherapy?*
No
Yes
Are you currently taking any chemotherapy medications?*
No
Yes
Are you currently using Retin-A or "Alpha Hydroxy" skin care products? (If so, avoid use for 1 month following procedure)*
No
Yes
Do you wear contact lenses?*
No
Yes
Are you allergic to any metal? (e.g. Can you only wear 14k gold):*
No
Yes
Have you ever had any permanent makeup procedures prior to this appointment with Ivonne?*
No
Yes

If "yes" when?:
Are you taking medication, including immunosuppressive, such as anti-inflammatory or steroids?*
No
Yes
Are you in withdrawal from caffeine products?*
No
Yes
Are you allergic to topical antibiotic numbing creams or desensitizers?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you*
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes
Are you currently taking medication for high or low blood pressure?*
No
Yes
Will you work out on the day of treatment?*
No
Yes

No. of times you work out weekly
Have you consumed alcohol on the date of treatment?*
No
Yes

Health Questionnaire Part 2.

Do you have now, or previously had any of the following:
Tuberculosis
Heart issue/Pace Maker
Trichotillomania
Allergies to makeup
Accutane treatment
Dry eyes
Keloids
Thyroid Issues/Meds
Diabetes (type 1)
Stroke/Paralysis
Chest pains
Shortness of breath
Alopecia
Epilepsy/seizure
Smoker
Cataract surgery
Tear duct plugs
Planning on having Facial Plastic Surgery
Cancer (List below)
Tan Regularly
Organ transplant
Vitiligo
Scar(s) in area to be done?
Botox
Other Medical Conditions/Surgeries (list below)
MRSA/Staph
Bleeding Disorder
Eczema/Dermatitis
Hepatitis/Jaundice/HIV
Kidney Disease
Cold sores
Glaucoma
Body runs hot
Hyper-pigmentation
Hypo-pigmentation
Herpes Simplex
Refractive eye surgery
Autoimmune disorders
Shingles (on face)
Eyelid surgery
Lasik surgery
Ocular Herpes
Head Injury/Trauma
Forehead/Brow Lift
Rosacea (on the face)
Lash/Brow Growth Serum
Oily/Combination-Severe Oily skin

Planning on having Facial Plastic Surgery
 Date surgery scheduled:

Botox (date of last treatment)

Please explain any question marked "YES", list any other medical conditions or allergies, and list all your medications:

Consent to be Photographed.

I consent to the reproduction and use of my photo(s) (without identifying client name or identifying marks) with this consent. Consent is for the use of any photograph including but not limited to the use of my photos for any educational purposes, including instruction, display to professional organizations, websites, social media and marketing/advertising thereof.

This consent, as stated above, shall be a continuing consent for all procedures, past, present and future.  Written notice must be received from me the client asking to discontinue use. (60 days written notice is required).

I give Ivonne Sanchez or Ivonne Sanchez permission to use my photo(s) as checked below:
Full Face
Eyebrows with Eyes Only
Lips
Eyes

What is the date of service: *

What is the procedure being performed: *

What is the cost of the service? *

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Age

How you found us:
Area(s) Treated / Treatment Procedure (Please Check):
Eyebrows
Lips
Eyeliner
Other

If other:

Health Questionnaire Part 1.

To help avoid unforeseen complications, please answer the following questions:

Are you over the age of 18? (You must be 18 years of age to receive our services).*
No
Yes
Have you had any aspirin or blood thinning products within the last 7 days?*
No
Yes
Have you taken any mood-altering drugs within the last 8 hours? (e.g. Xanax)*
No
Yes
Do you have any history of cold sores, herpes, or fever blisters?*
No
Yes
Are you sensitive to Latex or Nitrile?*
No
Yes
Have you had a chemical or laser peel?*
No
Yes
Do you have problems with healing?*
No
Yes
Have you had previous problems with tattoos or has your physician advised you not to have a tattoo at this time?*
No
Yes
Are you currently undergoing radiation or chemotherapy?*
No
Yes
Are you currently taking any chemotherapy medications?*
No
Yes
Are you currently using Retin-A or "Alpha Hydroxy" skin care products? (If so, avoid use for 1 month following procedure)*
No
Yes
Do you wear contact lenses?*
No
Yes
Are you allergic to any metal? (e.g. Can you only wear 14k gold):*
No
Yes
Have you ever had any permanent makeup procedures prior to this appointment with Ivonne?*
No
Yes

If "yes" when?:
Are you taking medication, including immunosuppressive, such as anti-inflammatory or steroids?*
No
Yes
Are you in withdrawal from caffeine products?*
No
Yes
Are you allergic to topical antibiotic numbing creams or desensitizers?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you*
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes
Are you currently taking medication for high or low blood pressure?*
No
Yes
Will you work out on the day of treatment?*
No
Yes

No. of times you work out weekly
Have you consumed alcohol on the date of treatment?*
No
Yes

Health Questionnaire Part 2.

Do you have now, or previously had any of the following:
Tuberculosis
Heart issue/Pace Maker
Trichotillomania
Allergies to makeup
Accutane treatment
Dry eyes
Keloids
Thyroid Issues/Meds
Diabetes (type 1)
Stroke/Paralysis
Chest pains
Shortness of breath
Alopecia
Epilepsy/seizure
Smoker
Cataract surgery
Tear duct plugs
Planning on having Facial Plastic Surgery
Cancer (List below)
Tan Regularly
Organ transplant
Vitiligo
Scar(s) in area to be done?
Botox
Other Medical Conditions/Surgeries (list below)
MRSA/Staph
Bleeding Disorder
Eczema/Dermatitis
Hepatitis/Jaundice/HIV
Kidney Disease
Cold sores
Glaucoma
Body runs hot
Hyper-pigmentation
Hypo-pigmentation
Herpes Simplex
Refractive eye surgery
Autoimmune disorders
Shingles (on face)
Eyelid surgery
Lasik surgery
Ocular Herpes
Head Injury/Trauma
Forehead/Brow Lift
Rosacea (on the face)
Lash/Brow Growth Serum
Oily/Combination-Severe Oily skin

Planning on having Facial Plastic Surgery
 Date surgery scheduled:

Botox (date of last treatment)

Please explain any question marked "YES", list any other medical conditions or allergies, and list all your medications:

Consent to be Photographed.

I consent to the reproduction and use of my photo(s) (without identifying client name or identifying marks) with this consent. Consent is for the use of any photograph including but not limited to the use of my photos for any educational purposes, including instruction, display to professional organizations, websites, social media and marketing/advertising thereof.

This consent, as stated above, shall be a continuing consent for all procedures, past, present and future.  Written notice must be received from me the client asking to discontinue use. (60 days written notice is required).

I give Ivonne Sanchez or Ivonne Sanchez permission to use my photo(s) as checked below:
Full Face
Eyebrows with Eyes Only
Lips
Eyes

What is the date of service: *

What is the procedure being performed: *

What is the cost of the service? *

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Age

How you found us:
Area(s) Treated / Treatment Procedure (Please Check):
Eyebrows
Lips
Eyeliner
Other

If other:

Health Questionnaire Part 1.

To help avoid unforeseen complications, please answer the following questions:

Are you over the age of 18? (You must be 18 years of age to receive our services).*
No
Yes
Have you had any aspirin or blood thinning products within the last 7 days?*
No
Yes
Have you taken any mood-altering drugs within the last 8 hours? (e.g. Xanax)*
No
Yes
Do you have any history of cold sores, herpes, or fever blisters?*
No
Yes
Are you sensitive to Latex or Nitrile?*
No
Yes
Have you had a chemical or laser peel?*
No
Yes
Do you have problems with healing?*
No
Yes
Have you had previous problems with tattoos or has your physician advised you not to have a tattoo at this time?*
No
Yes
Are you currently undergoing radiation or chemotherapy?*
No
Yes
Are you currently taking any chemotherapy medications?*
No
Yes
Are you currently using Retin-A or "Alpha Hydroxy" skin care products? (If so, avoid use for 1 month following procedure)*
No
Yes
Do you wear contact lenses?*
No
Yes
Are you allergic to any metal? (e.g. Can you only wear 14k gold):*
No
Yes
Have you ever had any permanent makeup procedures prior to this appointment with Ivonne?*
No
Yes

If "yes" when?:
Are you taking medication, including immunosuppressive, such as anti-inflammatory or steroids?*
No
Yes
Are you in withdrawal from caffeine products?*
No
Yes
Are you allergic to topical antibiotic numbing creams or desensitizers?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you*
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes
Are you currently taking medication for high or low blood pressure?*
No
Yes
Will you work out on the day of treatment?*
No
Yes

No. of times you work out weekly
Have you consumed alcohol on the date of treatment?*
No
Yes

Health Questionnaire Part 2.

Do you have now, or previously had any of the following:
Tuberculosis
Heart issue/Pace Maker
Trichotillomania
Allergies to makeup
Accutane treatment
Dry eyes
Keloids
Thyroid Issues/Meds
Diabetes (type 1)
Stroke/Paralysis
Chest pains
Shortness of breath
Alopecia
Epilepsy/seizure
Smoker
Cataract surgery
Tear duct plugs
Planning on having Facial Plastic Surgery
Cancer (List below)
Tan Regularly
Organ transplant
Vitiligo
Scar(s) in area to be done?
Botox
Other Medical Conditions/Surgeries (list below)
MRSA/Staph
Bleeding Disorder
Eczema/Dermatitis
Hepatitis/Jaundice/HIV
Kidney Disease
Cold sores
Glaucoma
Body runs hot
Hyper-pigmentation
Hypo-pigmentation
Herpes Simplex
Refractive eye surgery
Autoimmune disorders
Shingles (on face)
Eyelid surgery
Lasik surgery
Ocular Herpes
Head Injury/Trauma
Forehead/Brow Lift
Rosacea (on the face)
Lash/Brow Growth Serum
Oily/Combination-Severe Oily skin

Planning on having Facial Plastic Surgery
 Date surgery scheduled:

Botox (date of last treatment)

Please explain any question marked "YES", list any other medical conditions or allergies, and list all your medications:

Consent to be Photographed.

I consent to the reproduction and use of my photo(s) (without identifying client name or identifying marks) with this consent. Consent is for the use of any photograph including but not limited to the use of my photos for any educational purposes, including instruction, display to professional organizations, websites, social media and marketing/advertising thereof.

This consent, as stated above, shall be a continuing consent for all procedures, past, present and future.  Written notice must be received from me the client asking to discontinue use. (60 days written notice is required).

I give Ivonne Sanchez or Ivonne Sanchez permission to use my photo(s) as checked below:
Full Face
Eyebrows with Eyes Only
Lips
Eyes

What is the date of service: *

What is the procedure being performed: *

What is the cost of the service? *

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Age

How you found us:
Area(s) Treated / Treatment Procedure (Please Check):
Eyebrows
Lips
Eyeliner
Other

If other:

Health Questionnaire Part 1.

To help avoid unforeseen complications, please answer the following questions:

Are you over the age of 18? (You must be 18 years of age to receive our services).*
No
Yes
Have you had any aspirin or blood thinning products within the last 7 days?*
No
Yes
Have you taken any mood-altering drugs within the last 8 hours? (e.g. Xanax)*
No
Yes
Do you have any history of cold sores, herpes, or fever blisters?*
No
Yes
Are you sensitive to Latex or Nitrile?*
No
Yes
Have you had a chemical or laser peel?*
No
Yes
Do you have problems with healing?*
No
Yes
Have you had previous problems with tattoos or has your physician advised you not to have a tattoo at this time?*
No
Yes
Are you currently undergoing radiation or chemotherapy?*
No
Yes
Are you currently taking any chemotherapy medications?*
No
Yes
Are you currently using Retin-A or "Alpha Hydroxy" skin care products? (If so, avoid use for 1 month following procedure)*
No
Yes
Do you wear contact lenses?*
No
Yes
Are you allergic to any metal? (e.g. Can you only wear 14k gold):*
No
Yes
Have you ever had any permanent makeup procedures prior to this appointment with Ivonne?*
No
Yes

If "yes" when?:
Are you taking medication, including immunosuppressive, such as anti-inflammatory or steroids?*
No
Yes
Are you in withdrawal from caffeine products?*
No
Yes
Are you allergic to topical antibiotic numbing creams or desensitizers?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you*
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes
Are you currently taking medication for high or low blood pressure?*
No
Yes
Will you work out on the day of treatment?*
No
Yes

No. of times you work out weekly
Have you consumed alcohol on the date of treatment?*
No
Yes

Health Questionnaire Part 2.

Do you have now, or previously had any of the following:
Tuberculosis
Heart issue/Pace Maker
Trichotillomania
Allergies to makeup
Accutane treatment
Dry eyes
Keloids
Thyroid Issues/Meds
Diabetes (type 1)
Stroke/Paralysis
Chest pains
Shortness of breath
Alopecia
Epilepsy/seizure
Smoker
Cataract surgery
Tear duct plugs
Planning on having Facial Plastic Surgery
Cancer (List below)
Tan Regularly
Organ transplant
Vitiligo
Scar(s) in area to be done?
Botox
Other Medical Conditions/Surgeries (list below)
MRSA/Staph
Bleeding Disorder
Eczema/Dermatitis
Hepatitis/Jaundice/HIV
Kidney Disease
Cold sores
Glaucoma
Body runs hot
Hyper-pigmentation
Hypo-pigmentation
Herpes Simplex
Refractive eye surgery
Autoimmune disorders
Shingles (on face)
Eyelid surgery
Lasik surgery
Ocular Herpes
Head Injury/Trauma
Forehead/Brow Lift
Rosacea (on the face)
Lash/Brow Growth Serum
Oily/Combination-Severe Oily skin

Planning on having Facial Plastic Surgery
 Date surgery scheduled:

Botox (date of last treatment)

Please explain any question marked "YES", list any other medical conditions or allergies, and list all your medications:

Consent to be Photographed.

I consent to the reproduction and use of my photo(s) (without identifying client name or identifying marks) with this consent. Consent is for the use of any photograph including but not limited to the use of my photos for any educational purposes, including instruction, display to professional organizations, websites, social media and marketing/advertising thereof.

This consent, as stated above, shall be a continuing consent for all procedures, past, present and future.  Written notice must be received from me the client asking to discontinue use. (60 days written notice is required).

I give Ivonne Sanchez or Ivonne Sanchez permission to use my photo(s) as checked below:
Full Face
Eyebrows with Eyes Only
Lips
Eyes

What is the date of service: *

What is the procedure being performed: *

What is the cost of the service? *

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
Participant'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.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Age

How you found us:
Area(s) Treated / Treatment Procedure (Please Check):
Eyebrows
Lips
Eyeliner
Other

If other:

Health Questionnaire Part 1.

To help avoid unforeseen complications, please answer the following questions:

Are you over the age of 18? (You must be 18 years of age to receive our services).*
No
Yes
Have you had any aspirin or blood thinning products within the last 7 days?*
No
Yes
Have you taken any mood-altering drugs within the last 8 hours? (e.g. Xanax)*
No
Yes
Do you have any history of cold sores, herpes, or fever blisters?*
No
Yes
Are you sensitive to Latex or Nitrile?*
No
Yes
Have you had a chemical or laser peel?*
No
Yes
Do you have problems with healing?*
No
Yes
Have you had previous problems with tattoos or has your physician advised you not to have a tattoo at this time?*
No
Yes
Are you currently undergoing radiation or chemotherapy?*
No
Yes
Are you currently taking any chemotherapy medications?*
No
Yes
Are you currently using Retin-A or "Alpha Hydroxy" skin care products? (If so, avoid use for 1 month following procedure)*
No
Yes
Do you wear contact lenses?*
No
Yes
Are you allergic to any metal? (e.g. Can you only wear 14k gold):*
No
Yes
Have you ever had any permanent makeup procedures prior to this appointment with Ivonne?*
No
Yes

If "yes" when?:
Are you taking medication, including immunosuppressive, such as anti-inflammatory or steroids?*
No
Yes
Are you in withdrawal from caffeine products?*
No
Yes
Are you allergic to topical antibiotic numbing creams or desensitizers?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you*
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any allergies? If yes, list in space provided at the end of the form.*
No
Yes
Are you currently taking medication for high or low blood pressure?*
No
Yes
Will you work out on the day of treatment?*
No
Yes

No. of times you work out weekly
Have you consumed alcohol on the date of treatment?*
No
Yes

Health Questionnaire Part 2.

Do you have now, or previously had any of the following:
Tuberculosis
Heart issue/Pace Maker
Trichotillomania
Allergies to makeup
Accutane treatment
Dry eyes
Keloids
Thyroid Issues/Meds
Diabetes (type 1)
Stroke/Paralysis
Chest pains
Shortness of breath
Alopecia
Epilepsy/seizure
Smoker
Cataract surgery
Tear duct plugs
Planning on having Facial Plastic Surgery
Cancer (List below)
Tan Regularly
Organ transplant
Vitiligo
Scar(s) in area to be done?
Botox
Other Medical Conditions/Surgeries (list below)
MRSA/Staph
Bleeding Disorder
Eczema/Dermatitis
Hepatitis/Jaundice/HIV
Kidney Disease
Cold sores
Glaucoma
Body runs hot
Hyper-pigmentation
Hypo-pigmentation
Herpes Simplex
Refractive eye surgery
Autoimmune disorders
Shingles (on face)
Eyelid surgery
Lasik surgery
Ocular Herpes
Head Injury/Trauma
Forehead/Brow Lift
Rosacea (on the face)
Lash/Brow Growth Serum
Oily/Combination-Severe Oily skin

Planning on having Facial Plastic Surgery
 Date surgery scheduled:

Botox (date of last treatment)

Please explain any question marked "YES", list any other medical conditions or allergies, and list all your medications:

Consent to be Photographed.

I consent to the reproduction and use of my photo(s) (without identifying client name or identifying marks) with this consent. Consent is for the use of any photograph including but not limited to the use of my photos for any educational purposes, including instruction, display to professional organizations, websites, social media and marketing/advertising thereof.

This consent, as stated above, shall be a continuing consent for all procedures, past, present and future.  Written notice must be received from me the client asking to discontinue use. (60 days written notice is required).

I give Ivonne Sanchez or Ivonne Sanchez permission to use my photo(s) as checked below:
Full Face
Eyebrows with Eyes Only
Lips
Eyes

What is the date of service: *

What is the procedure being performed: *

What is the cost of the service? *

COVID-19 Screening Questions

If you have travelled outside of Canada (or have been exposed to someone who a confirmed case of COVID-19) within 14 days of your scheduled appointment you must have subjected yourself to a period of self-isolation and quarantine before you are eligible to receive any services at Ivonne Sanchez Beauty.

Have you travelled outside of Canada within the past 14 days of the scheduled day of treatment?*
No
Yes
If you have travelled outside of Canada (or have been in contact with someone with COVID-19) within the past 14 days have you developed a cough, fever, or experienced difficulty breathing?*
No
Yes
For personal services such as those offered at Ivonne Sanchez Beauty the nature of work performed requires close contact with colleagues and customers (i.e. within 2 metres). These interactions, as well as the need to touch work surfaces and equipment could increase the likelihood that we or you could come in contact with the virus. *
I Agree
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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