I am over the age of 18 and desire Luxury Brow KC to perform the elective cosmetic pigmentation procedure. I understand that this procedure is for cosmetic purposes only and not for health reasons. I am aware that no guarantees have been made to me concerning the results of the procedure(s). I also understand that the permanent skin pigmentation procedure carries with it the possible complications and consequences associated with this type of cosmetic procedure, which includes risk of infection, scarring, eye damage, inconsistent color, hemorrhage, and possible spreading, fanning or fading of pigments and/or allergic reaction to any products used. I understand the actual color of the pigment may be modified slightly due to the tone and color of my skin. Laser treatments may also compromise the cosmetic pigmentation procedure. I fully understand as with all such procedures that this is not a science but rather an art and that anything that can go wrong may go wrong. I request the permanent skin pigmentation procedure, accepting the permanency of the procedure as well as the possible complications and consequences of the said procedure(s). For the purpose of documentation, I also consent to the taking of before, during and after photographs/videos of said procedure(s) which become the technician's sole property and may or may not be used for whatever purposes deemed necessary, including using pictures for social media and advertising publications. IF YOU DO NOT WANT YOUR PICTURES POSTED ONLINE PLEASE ADVISE YOUR TECHNICIAN. Understanding the permanent skin pigmentation procedure, the permanency of the procedure, the possible consequences of the procedure, and that the procedure is for cosmetic purposes only, I hereby authorize Luxury Brow to perform the permanent skin pigmentation procedure(s). I certify that I have read and initialed the above paragraphs and have had explained to me and fully understand the above consent and procedure permit; that the explanations therein referred to were made and I accept full responsibility for these and/or any other complications which may arise or result during or following the cosmetic procedure(s) which is to be performed at my request according to this consent. Please intial: Do you agree to the fees discussed? I fully understand that a cancelation fee of 50% of the price of the procedure will be charged or deducted off the deposit in the event of cancellation of procedure with less then 48 hour notice. The entire staff is dedicated to client satisfaction. We employ a no refund policy and I am aware of this. I absolutely understand that this procedure is a process and subsequent visits are necessary in order to achieve desired results. Subsequent visits are subject to $100/$300. charge depending upon the amount of work needed. There is a possibility of an allergic retain of pigments. A patch test if advisable however it does not ensure a client will not have an allergic reaction. Patch test: If you are concerned about potential reactions to pigment, please make a seperate appointment for a patch test. By initialing, you are bypassing the patch test and assume responsability for any reactions that may occur. If waived, I release Luxury Brow from liability if I develop an allergic reaction to the pigment. (Pigments contents are: iron oxide, lakes, alcohol, Glycerine and distilled/sterile water) | acknowledge that NO GUARANTEES have been made to me concerning the results of this procedure. Laser treatments or ANY kind of facial injections may also compromise your permanent cosmetic makeup application. You must wait 3 weeks after any facial injections before receiving cosmetic pigmentation. I certify that I have read and initialed the above paragraphs and have had explained to me fully and understand the above consent and procedure permit; that the explanations therein referred to were made and I accept full responsibility for these and/or any other complications which may arise or result during or following the cosmetic procedure(s) which is to be performed at my request according to this consent were filled in before I signed this statement. Today's Date: September 27, 2023 |