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Please read through this document thoroughly.

This document outlines and confirms your understanding our safety and health protocols for all permanent makeup services (Microblading and Brow services, Lip Blush tattoo, Eyeliner, Feckles, Birth Marks, and Scalp Micropigmentation) and includes informaton regarding:

  • Contraindications
  • Possible Risks, Hazards or Complications
  • Policies 
  • Care and Maintenance 
  • Consent & Release Agreement 
  • Photography Release Agreement

 

 

CONTRAINDICATIONS

In medicine, a contraindication (of a condition or circumstance) suggest or indicate that (a particular technique or drug) should not be used in the case in question..

I confrim that:

I have completed, submitted and went over my pre-screening questionaire with my artist and DO NOT have any current or existing contraindications.

OR

Have had a phone or in personal consultation with my aritst and  DO NOT have any current or exisiting contraindications.

I Agree

OR

I have completed, submitted and went over my pre-screening questionaire and/or consultation with my artist and DO have a current or existing contraindations. I understand that because of this, my results can be impacted in shape, color and retainment. I also know I may be asked at any given time to provide a clearance note from my doctor for health conditions similar to the following: 

I Agree

  •  Diabetes Type 1 and 2 and Diabetics who are on insulin
  •  Auto-immune disease
  • Thyroid / Graves’ disease
  • Cancer (surviror) within the last 2 years * Requires doctors note 

 

POSSIBLE  RISKS  +  HAZARDS / COMPLICATIONS

On average, permanent makeup appointments can last between 2/12 - 4 hours however, We CANNOT guarantee this for all clients. It’s important that you understand that satisfactory results of this procedure depend 50% on the artist, and 50% is up to your skin and how you care for your tattoo after you leave our studio.

** Allergic reaction – Allergic reactions can occur from any anesthetics used during the procedure. If you do suffer from an allergic reaction, you should contact your doctor immediately. Allergic reaction response may show through redness, swelling, rash, blistering, dryness or any other symptoms associated with an allergic reaction. You may take a 5-7 day patch test to determine this.

** Pain & Numbness – We cannot accept responsibility if the area to be treated does not respond to the numbing cream. Each individual is different according to skin type. Some clients report the area to be completely numb, while others may experience some discomfort.

For microblading procedure, a numbing cream/gel is used. The products are formulated to be perfectly safe and can be purchased over the counter from any pharmacy/chemist (Lidocaine, Prilocaine, Benzocaine, Tetracaine and Epinephrine cream or gel form typically used). The anesthetic is placed over the treatment area for 20-30 minutes then carefully removed prior to treatment. As a result of the treatment, combined with the use of the anesthetic, you can expect to experience some redness/swelling that can last 1-4 days. You should always follow your post procedure advice and after care for the best results.

** Uneven pigmentation: This can result from poor healing, infection, bleeding or many other causes. Your follow up appointment will likely correct any uneven appearances.

** Asymmetry: Every efforts will be made to avoid asymmetry but our faces are not symmetrical so adjustments may be needed during the follow up session to correct any unevenness

** MRI: Because pigments used in Permanent Cosmetic procedures contain inert oxides, a low level magnet may be required if you need to be scanned by an MRI machine. You must inform your MRI Technician of any tattoos or permanent cosmetics.

 

POSSIBLE INFECTIONS

Although it's important to note that infections during the microblading process are VERY RARE (about 1-3% or 1-3 in 100 people), it's important to understand what risks it can include and how to treat it if your suspect it. 

All instruments that enter the skin or come in contact with body fluids are disposable, and disposed of after use. Cross contamination guidelines are strictly adhered to. If at any point the area treated becomes red, itchy, oozing, overly inflamed these are possible signs of infection, you must contact a doctor or go to the nearest medical facility immediately.

It is highly crucial that you follow the aftercare process to a T as there can be a small risk (around 1-3%) that you may experience an infection if not taken with proper care. In mild cases, infections can be treated with over the counter antibiotics that can be topically placed on your skin. In extream, serious cases, you may need to see a doctor and recieve a perscibed antibotic that you cannont recieve over the counter. The biggest risk in developing a deep infection to the skin can turn into a condition known as "Cellulitis". Cellulities is an infection of the inner layer of the skin that can spread if not treated appropriately. Other conditons such as Nickel reactions and rashes can occur if the client is allergic to the pigment that is placed on their skin. (Please note, Huemon Beauty Pigments are water based and do not include Nickel but this is important to know in case you ever decide to recieve microblading services from another establishment.)  If you suspect that you have an infection, please contact a Huemon Beauty speciliast immediately

Early stage infection systems:

  • Odor comming from your eyebrow
  • Discharge that may be a greenish/brown color
  • Resness around the procedure area but not extending beyond it
  • Tenderness when touch *Please avoide touching your eyebrows after the procedure!

​Most of these systems can be treated as long as you catch it early. Please consider these tips if you have an early infection:

  • Consider using an antibiotic ointment like Bacitracin. Bacitracin will treat the most common skin pathogens such as staph and strep (even MRSA) and does not include ointments that can irritate the skin.
  • Avoid using triple antibiotic ointment like neosporin which contains neomycin that approximately 1 in 10 people react to with a rash (that's a LOT of people). 
  • Avoid covering up the microbladed brow with creams and gels such as vaseline or other emollients which can trap in heat and keep an infection in the wound (remember bacteria dies in the presence of oxygen)
  • Consider using a cold pack on your eyebrows to reduce swelling and heat, this can also help alleviate some of the pain/tenderness
  • Keep the area clean! Avoid using makeup or other topical agents (besides the antibiotic) on your skin/wound

​If the infection continues to develop and you begin to experience; exteme swelling/tenderness/pain or fever/chills (signs suggest you have a systemic infection) please contact your doctor ASAP. These are early signs that you may be developing facial cellulities and may need oral or IV antibotics.

 

CARE & MAINTENANCE 

Aftercare is a crucial element to follow to ensure proper healing and color retention. Results vary for all individuals and we cannot guarantee your results.Please do not use other products or follow other artist’s aftercare instructions during your healing process.

Please follow the aftercare directed for the appopriate service. This information can be found on our website and will also be given to you by your artist. 

I agree to follow the care and maintenance instructions provided by the Artist for the care of the Procedure area following the Procedure, and that if any follow up care is required due to my own mistake or negligence, or failure to follow these instructions, this will be at my own expense and risk. I understand that failure to follow aftercare instructions may result in permanent damage to my skin, scarring and may prevent the pigment from settling. I agree to keep the procedure area clean and to follow aftercare instructions. This includes exercising, tanning, and skincare products. *

I Agree

Any procedure that breaks the skin requires healing time, which can cause the healing process to be full of ups and downs. Here are some important reminders about the healing process to note during your journey.

  1. Always wash your hands thoroughly with anti-bacterial soap before touching the tattooed area. You don’t want to get the area infected!
  2. Do not wash or put anything on your tattoo that has not been given to directly by your artist.
  3. Do not rub/scratch or traumatize the procedure area while it is healing; touching the procedure area with your fingers may cause an infection from unseen bacteria. Furthermore, your fingers may have added oils that can cause the pigment color to be removed.
  4. Sabbing in a normal part of the healing process. Don't freak out if your scabbing comes off and it looks like it's taking pigment away with it. This process can leave a "patchy' let the scabs fall off NATURALLY. Picking your scabs can cause scarring, premature loss of pigment/hair and even an infection. The approximate scabbing period is typically 7-14 days however, healing can be prolonged if you’re immune system is compromised if you are generally stressed, and by poor diet.
  5. No makeup on/around your treatment area while healing.
  6. No sweating (salt is your worse enemy and will draw out the pigment!); No heavy work outs, saunas, laying out in the sun, swimming in chlorinated pools/ jacuzzi’s/ocean until area is completely healed.
  7. Absolutely no sun exposure or tanning for 3-4 weeks after procedure.
  8. If you are a “face-sleeper” then sleeping on clean, satin pillowcase is suggest while the procedure area is healing.
  9. If you’re a blood donor, you may not give blood for 1 year following your procedure (Per Red Cross)
  10. Trust the process! 

 

POLICIES

I understand that there is a $150.00 NON -refundable, but transferable, deposit to hold my appointment. This amount will go towards the remaining amount due before the time of my appointment. 

I understand that Huemon Beauty will assess a late fee charge of $35.00 if I am more than 15 minutes late to my appointment. If I arrive more than 30 minutes late, I will forfeit my appointment and will need to reschedule at a later time. 

I understand that Huemon Beauty has the right to forfeit my appointment at any given time if I fail to adhere to their policies or any part of the permanent makeup treatment process. 

Touch-ups that are scheduled outside of the aloted time frame/grace period will incur a $150.00 fee.

CONSENT & RELEASE AGREEMENT  

I am over the age of 18, am not under the influence of drugs or alcohol, I am not pregnant or nursing and desire to receive the indicated semi-permanent pigmentation procedure. The general nature of cosmetic micro-pigmentation, as well as the specific procedure performed has been explained to me. Furthermore I consent to the following:

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 have been informed of the nature, risks, and possible complications and consequences of permanent skin pigmentation. Understanding that permanent skin pigmentation procedure carries known and unknown complications and consequences associated with this type of cosmetic procedure, including but not limited to: infection, scarring, inconsistent color, and spreading, fanning or fading of pigments.

I authorize my technician to use his/her professional judgment to decide what he/she feels is necessary under the given circumstances that any unforeseen conditions arise during the course of my procedure.

I fully understand this is a tattoo process and therefore not an exact science but an art.

I accept the responsibility for determining the color, shape and position of the micro blading procedure as agreed during consultation.

I understand the actual color of the pigment may be modified slightly, due to the tone and color of my skin.

I fully understand and accept that non-toxic pigments are used during the procedure and that the result achieved may fade over a period of 1-3 years. Even once the color fades, pigment itself may stay in the skin indefinitely. 

I have been informed that the highest standards of hygiene are met and that sterile, disposable needles and pigment containers 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 desired results and that 100% success cannot be guaranteed during the first procedure. I understand that I may have to return for a repeated procedure.

Upon completion of the procedure there might be swelling and redness of the skin, which will subside within 1-4 days. In some cases, bruising may occur. You may resume normal activities following the procedure, however, using cosmetics, excessive perspiration and exposure to the sun should be limited until the skin has fully healed.

I have been advised that the true color will be seen 6 weeks after each procedure, and that the pigment may vary according to skin tones, skin type, age and skin condition. 

Aftercare instructions have been explained to me and a written copy will be given to me to retain in my possession, which I will follow the best of my ability. If I have questions, I will call or email you. 

I agree to follow all pre-procedure and post-procedure instructions as provided and explained to me by the technician. Failure to do so may jeopardize my chances for a successful procedure.

I understand that Retin A. Renova, Alpha Hydroxy and Glycolic Acids must not be used on treated areas. They will alter the color .

Retin- A: Originally used as an acne treatement but now has numerous uses, including an exfoliating agent and “Keratolytic” (a product that removed a plug out of a hair follicle or sweat gland)

Alpha hydroxy acids (AHAs): is the group name for several types of acids that are naturally found in different foods and plants. They're a group of "peeling" agents that exfoliate chemically. They help prevent dead skin cells from sticking together, making it easier to exfoliate and giving you a more radiant, glowing skin.

Glycolic acid is part of the group of active compounds known as AHA's (alpha hydroxy acids). Derived from cane sugar: It has the smallest molecules in the group so is able to penetrate skin deeply and easily, making it the most effective for treating fine lines, acne, blackheads, dullness, oiliness etc.

I understand that sun, tanning beds, pools and some skin care products and medications can affect my permanent makeup. 

I will tell all skin care professionals or medical personnel about my permanent makeup procedures, especially if I’m scheduled for an MRI.

I accept the responsibility for my explanation to you of my desire for specific colors, shape and position for any procedure done today. 

I understand that implanted pigment color can slightly change or fade overtime due to circumstances beyond your control and I may need to maintain the color with future applications and touch up sessions within three (3) months of my initial procedure. 

I acknowledge that the proposed procedure(s) involve risk inherent in the procedure and have possibilities of complications during and/or following the procedures such as: infection, misplaced pigment, poor color retention and hyperpigmentation. 

I have been quoted the cost of today’s appointment, which includes one (1) touchup within a two month (2) period and requires a $50.00 non-refunable deposit made to Huemon Beauty today. The remainig payment of the service(s) I've been quoted for today will be due at the time of service. I understand that Huemon Beauty does not provide refunds for this/these elective procedures if I cancel my appointment less than 72 hours of my appointment date. 

I understand that if I choose to reschedule my appointment, that the time I desire may not be avliable. If I need to reschedule my appointment and it exceeds  the two month (2 month) timeframe, I understand that I will be charged an additonal $100.00 for my intiial service/touch up service.

I certify that I have read or have had read to me the contents of this form. I understand the risks and alternatives involved in this procedure(s) and I have had the opportunity to ask questions and all my questions have been answered. I acknowledge that I have reviewed and approved the materials given to me and I authorize Deyonne Hallberg, owner and certified microblading technician/artist of Huemon Beauty, to perform on my body the Huemon Beauty microblading procedure desired today.

First Client Name

First Name*

Last Name*

Phone*
First Client Date of Birth*
First Client In Take & Health History

Today's Date

Personal Information


Please provide your mailing address *

Emergency Contact (Name, Relation, Phone Number)

Statement of Consent - Patch Test

Allergic reactions can occur from any anesthetics used during the procedure. If your concerned about the possible implications of your procedure, please select to "take" the patch test. 

Please Note: Once you agree to have the patch test performed, Huemon Beauty will take a small sample test on your forearm the day of, or before your treatment. If you show any signs of a reaction, Huemon Beauty will not be able to perform the desired treatment on you until you have documented written consent from your primary doctor. Reaction responses may show through redness, swelling, rash or blistering.

Photo Release 

We would like your permission to use these photos for advertising; i.e. professional portfolios, online marketing, print ads etc. Please indicate if you will authorize this usage*
First Client Signature*
Second Client Name

First Name*

Last Name*

Phone*
Second Client Date of Birth*
Second Client In Take & Health History

Today's Date

Personal Information


Please provide your mailing address *

Emergency Contact (Name, Relation, Phone Number)

Statement of Consent - Patch Test

Allergic reactions can occur from any anesthetics used during the procedure. If your concerned about the possible implications of your procedure, please select to "take" the patch test. 

Please Note: Once you agree to have the patch test performed, Huemon Beauty will take a small sample test on your forearm the day of, or before your treatment. If you show any signs of a reaction, Huemon Beauty will not be able to perform the desired treatment on you until you have documented written consent from your primary doctor. Reaction responses may show through redness, swelling, rash or blistering.

Photo Release 

We would like your permission to use these photos for advertising; i.e. professional portfolios, online marketing, print ads etc. Please indicate if you will authorize this usage*
Third Client Name

First Name*

Last Name*

Phone*
Third Client Date of Birth*
Third Client In Take & Health History

Today's Date

Personal Information


Please provide your mailing address *

Emergency Contact (Name, Relation, Phone Number)

Statement of Consent - Patch Test

Allergic reactions can occur from any anesthetics used during the procedure. If your concerned about the possible implications of your procedure, please select to "take" the patch test. 

Please Note: Once you agree to have the patch test performed, Huemon Beauty will take a small sample test on your forearm the day of, or before your treatment. If you show any signs of a reaction, Huemon Beauty will not be able to perform the desired treatment on you until you have documented written consent from your primary doctor. Reaction responses may show through redness, swelling, rash or blistering.

Photo Release 

We would like your permission to use these photos for advertising; i.e. professional portfolios, online marketing, print ads etc. Please indicate if you will authorize this usage*
Fourth Client Name

First Name*

Last Name*

Phone*
Fourth Client Date of Birth*
Fourth Client In Take & Health History

Today's Date

Personal Information


Please provide your mailing address *

Emergency Contact (Name, Relation, Phone Number)

Statement of Consent - Patch Test

Allergic reactions can occur from any anesthetics used during the procedure. If your concerned about the possible implications of your procedure, please select to "take" the patch test. 

Please Note: Once you agree to have the patch test performed, Huemon Beauty will take a small sample test on your forearm the day of, or before your treatment. If you show any signs of a reaction, Huemon Beauty will not be able to perform the desired treatment on you until you have documented written consent from your primary doctor. Reaction responses may show through redness, swelling, rash or blistering.

Photo Release 

We would like your permission to use these photos for advertising; i.e. professional portfolios, online marketing, print ads etc. Please indicate if you will authorize this usage*
Fifth Client Name

First Name*

Last Name*

Phone*
Fifth Client Date of Birth*
Fifth Client In Take & Health History

Today's Date

Personal Information


Please provide your mailing address *

Emergency Contact (Name, Relation, Phone Number)

Statement of Consent - Patch Test

Allergic reactions can occur from any anesthetics used during the procedure. If your concerned about the possible implications of your procedure, please select to "take" the patch test. 

Please Note: Once you agree to have the patch test performed, Huemon Beauty will take a small sample test on your forearm the day of, or before your treatment. If you show any signs of a reaction, Huemon Beauty will not be able to perform the desired treatment on you until you have documented written consent from your primary doctor. Reaction responses may show through redness, swelling, rash or blistering.

Photo Release 

We would like your permission to use these photos for advertising; i.e. professional portfolios, online marketing, print ads etc. Please indicate if you will authorize this usage*
Sixth Client Name

First Name*

Last Name*

Phone*
Sixth Client Date of Birth*
Sixth Client In Take & Health History

Today's Date

Personal Information


Please provide your mailing address *

Emergency Contact (Name, Relation, Phone Number)

Statement of Consent - Patch Test

Allergic reactions can occur from any anesthetics used during the procedure. If your concerned about the possible implications of your procedure, please select to "take" the patch test. 

Please Note: Once you agree to have the patch test performed, Huemon Beauty will take a small sample test on your forearm the day of, or before your treatment. If you show any signs of a reaction, Huemon Beauty will not be able to perform the desired treatment on you until you have documented written consent from your primary doctor. Reaction responses may show through redness, swelling, rash or blistering.

Photo Release 

We would like your permission to use these photos for advertising; i.e. professional portfolios, online marketing, print ads etc. Please indicate if you will authorize this usage*
Seventh Client Name

First Name*

Last Name*

Phone*
Seventh Client Date of Birth*
Seventh Client In Take & Health History

Today's Date

Personal Information


Please provide your mailing address *

Emergency Contact (Name, Relation, Phone Number)

Statement of Consent - Patch Test

Allergic reactions can occur from any anesthetics used during the procedure. If your concerned about the possible implications of your procedure, please select to "take" the patch test. 

Please Note: Once you agree to have the patch test performed, Huemon Beauty will take a small sample test on your forearm the day of, or before your treatment. If you show any signs of a reaction, Huemon Beauty will not be able to perform the desired treatment on you until you have documented written consent from your primary doctor. Reaction responses may show through redness, swelling, rash or blistering.

Photo Release 

We would like your permission to use these photos for advertising; i.e. professional portfolios, online marketing, print ads etc. Please indicate if you will authorize this usage*
Eighth Client Name

First Name*

Last Name*

Phone*
Eighth Client Date of Birth*
Eighth Client In Take & Health History

Today's Date

Personal Information


Please provide your mailing address *

Emergency Contact (Name, Relation, Phone Number)

Statement of Consent - Patch Test

Allergic reactions can occur from any anesthetics used during the procedure. If your concerned about the possible implications of your procedure, please select to "take" the patch test. 

Please Note: Once you agree to have the patch test performed, Huemon Beauty will take a small sample test on your forearm the day of, or before your treatment. If you show any signs of a reaction, Huemon Beauty will not be able to perform the desired treatment on you until you have documented written consent from your primary doctor. Reaction responses may show through redness, swelling, rash or blistering.

Photo Release 

We would like your permission to use these photos for advertising; i.e. professional portfolios, online marketing, print ads etc. Please indicate if you will authorize this usage*
Ninth Client Name

First Name*

Last Name*

Phone*
Ninth Client Date of Birth*
Ninth Client In Take & Health History

Today's Date

Personal Information


Please provide your mailing address *

Emergency Contact (Name, Relation, Phone Number)

Statement of Consent - Patch Test

Allergic reactions can occur from any anesthetics used during the procedure. If your concerned about the possible implications of your procedure, please select to "take" the patch test. 

Please Note: Once you agree to have the patch test performed, Huemon Beauty will take a small sample test on your forearm the day of, or before your treatment. If you show any signs of a reaction, Huemon Beauty will not be able to perform the desired treatment on you until you have documented written consent from your primary doctor. Reaction responses may show through redness, swelling, rash or blistering.

Photo Release 

We would like your permission to use these photos for advertising; i.e. professional portfolios, online marketing, print ads etc. Please indicate if you will authorize this usage*
Tenth Client Name

First Name*

Last Name*

Phone*
Tenth Client Date of Birth*
Tenth Client In Take & Health History

Today's Date

Personal Information


Please provide your mailing address *

Emergency Contact (Name, Relation, Phone Number)

Statement of Consent - Patch Test

Allergic reactions can occur from any anesthetics used during the procedure. If your concerned about the possible implications of your procedure, please select to "take" the patch test. 

Please Note: Once you agree to have the patch test performed, Huemon Beauty will take a small sample test on your forearm the day of, or before your treatment. If you show any signs of a reaction, Huemon Beauty will not be able to perform the desired treatment on you until you have documented written consent from your primary doctor. Reaction responses may show through redness, swelling, rash or blistering.

Photo Release 

We would like your permission to use these photos for advertising; i.e. professional portfolios, online marketing, print ads etc. Please indicate if you will authorize this usage*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
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 In Take & Health History

Today's Date

Personal Information


Please provide your mailing address *

Emergency Contact (Name, Relation, Phone Number)

Statement of Consent - Patch Test

Allergic reactions can occur from any anesthetics used during the procedure. If your concerned about the possible implications of your procedure, please select to "take" the patch test. 

Please Note: Once you agree to have the patch test performed, Huemon Beauty will take a small sample test on your forearm the day of, or before your treatment. If you show any signs of a reaction, Huemon Beauty will not be able to perform the desired treatment on you until you have documented written consent from your primary doctor. Reaction responses may show through redness, swelling, rash or blistering.

Photo Release 

We would like your permission to use these photos for advertising; i.e. professional portfolios, online marketing, print ads etc. Please indicate if you will authorize this usage*
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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