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Brow House Beauty

After care is very important for producing a beautiful and lasting result.

Keep the Brows lubricated never allowing them to dry and scab. DO NOT SUBMERGE OR SOAK for 14 days!

Minimize exposure from the sun, discourage swimming.

Apply ointment with freshly washed hands for 7-10 days. Never rubbing always patting. Less is more with the ointment. On average apply ointment 3xs a day, enough too moisturize. Never using too much. Brows should not look too shiny.
Properly cleanse the tattooed area with dial soap and water, lightly tapping the area, no scrubbing.

Do not scrub, rub or pick at the crust that forms. Allow it to flake off by itself. If it is removed before it is ready the pigment underneath it can be pulled out.

*If area gets itchy DO NOT scratch simply pat with ointment.

Do not use any makeup near the procedure area. • Do not workout while area is still healing.

Be careful when you sleep on your side, this can cause pigment to come out.

Mild swelling, itching, light scabbing light bruising and dry tightness. Aftercare balm can be used for scabbing and tightness.

Too dark and slightly uneven appearance. After 7-14 day the darkness will fade and once swelling dissipates unevenness usually disappears. If they are too dark or still a bit uneven after 4 weeks then we will make adjustments during the touch up appointment.

Color change or color loss. As the procedure area heals the color will lighten and sometimes seem to disappear. This can all be addressed during the touch up appointment and is Why the touchup is necessary. The procedure area has to be completely healed before we can address any concerns. This takes about four weeks.

**Failure to follow after care instructions may result in infections, Pigment loss or discoloration. client to consult a health care practitioner at the first sign of infection or allergic reaction and to report any diagnosed infection, allergic reaction, or adverse reaction to the department at 1-888-839-6676.

Consent and Release Agreement for 3D Microblading

Although 3D Microblading / semi- permanent technique is affective in most cases, absolutely no guarantee can be made regarding
 the client's benefit from the procedure.
This is the process of inserting pigment into the dermal layer of the skin and is a form of tattooing.

All instruments that enter the skin or come in contact with body fluids are sealed and sterilized before
 use and disposed of after use. Cross contamination guideline s are strictly adhered to.
Generally, the results are excellent. However, a perfect result is not a realistic expectation. It is usual to expect a touch up after the healing is completed. Initially the color will appear much more vibrant or darker compared to the end result. Usually within 7 days the color will fade 40% to 60%, soften and look more natural. After the 1st touch- up, the pigment is semi-permanent and will fade over time and will likely need to be FULLY touched up within 9 months to a year.

STATEMENT OF CONSENT AND RECITALS

Please read and initial all lines

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 to the best of my ability. If I have questions I will call or email you.

I understand that a certain amount of discomfort is associated with this procedure and that swelling, redness and bruising may occur. They will alter the color. 

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

I accept the responsibility to explain to you my desire for specific colors, shape, and positon for any procedure done today. 

I understand that implanted pigment color can slightly change or fade over time due to circumstances beyond your control and I will need to maintain the color with future applications and a touch up session within 30 days. 

I acknowledge that the proposed procedure involves risks inherent in the procedure and have
 possibilities of complications during and/or following the procedures such as: infection, misplaced pigment,
 poor color retention. 

I understand that by having a previous tattoo my Microblading/ Permanent makeup might not retain its pigment. 

I understand that I might require extra touch up if I have a previous Brow Tattoo. Not included in price. 

I understand that if I’m pregnant or breastfeeding it is my responsibility to talk to my Doctor about any complications. I understand this is not your responsibility & I will not hold you liable for any reason. 

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 and I have had the opportunity to ask questions and all of my
 questions have been answered. I understand that there is absolutely No Refund to this this elective procedure. 

[signed]

Possible risks, hazards or complications

  • Pain: There can be pain even after the topical anesthetic has been used. Anesthetics work better on some people than others.
  • Infection: Infection is very unusual. The areas treated must be kept clean and only freshly cleaned hands should touch the areas. See “After Care” sheet for instructions on care.
  • Uneven Pigmentation: This can result from poor healing, infection, bleeding or many other cau ses. Your follow up appointment will likely correct any uneven appearance.
  • Asymmetry: Every effort 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.
  • Excessive Swelling or Bruising: Some people bruise and swell more than others. Ice packs may help and the bruising and swelling typically disappears with 1- ‐5 days. Some people don’t bruise or swell at all.
  • Anesthesia: Topical anesthetics are used to numb the area to be tattooed. Lidocaine, Prilocaine, Benzocaine, Tetracaine and Epinephrine in a cream or gel form are typically used. If you are allergic to any of these please inform me now.

Today's Date: October 27, 2020

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Photography Release Consent
 We would like your permission to use your photos for advert ising. For example, our studio portfolios, online and print adds, etc. Your consent is necessary regarding.*
No
Yes

Medical History 

Do you presently have or previously had any of the following 

Diabetes*
No
Yes
Insulin*
No
Yes
Hepatitis (A,B,C,D)*
No
Yes
Easy bleeding*
No
Yes
Chemical Peel*
No
Yes

last treatment
Pregnant now/ Breast feeding now*
No
Yes
Accutane or acne treatment*
No
Yes
Tan by booth or sun*
No
Yes
Difficulty numbing with dental work Aspirin, Ibuprofen, alcohol, ect*
No
Yes
Cancer*
No
Yes

Year
Chemotherapy/ Radiation*
No
Yes
Taking blood thinners*
No
Yes
HIV/ Aids*
No
Yes
Keloids*
No
Yes
Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine*
No
Yes

If yes, please list

Any diseases or disorders not listed
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Photography Release Consent
 We would like your permission to use your photos for advert ising. For example, our studio portfolios, online and print adds, etc. Your consent is necessary regarding.*
No
Yes

Medical History 

Do you presently have or previously had any of the following 

Diabetes*
No
Yes
Insulin*
No
Yes
Hepatitis (A,B,C,D)*
No
Yes
Easy bleeding*
No
Yes
Chemical Peel*
No
Yes

last treatment
Pregnant now/ Breast feeding now*
No
Yes
Accutane or acne treatment*
No
Yes
Tan by booth or sun*
No
Yes
Difficulty numbing with dental work Aspirin, Ibuprofen, alcohol, ect*
No
Yes
Cancer*
No
Yes

Year
Chemotherapy/ Radiation*
No
Yes
Taking blood thinners*
No
Yes
HIV/ Aids*
No
Yes
Keloids*
No
Yes
Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine*
No
Yes

If yes, please list

Any diseases or disorders not listed
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Photography Release Consent
 We would like your permission to use your photos for advert ising. For example, our studio portfolios, online and print adds, etc. Your consent is necessary regarding.*
No
Yes

Medical History 

Do you presently have or previously had any of the following 

Diabetes*
No
Yes
Insulin*
No
Yes
Hepatitis (A,B,C,D)*
No
Yes
Easy bleeding*
No
Yes
Chemical Peel*
No
Yes

last treatment
Pregnant now/ Breast feeding now*
No
Yes
Accutane or acne treatment*
No
Yes
Tan by booth or sun*
No
Yes
Difficulty numbing with dental work Aspirin, Ibuprofen, alcohol, ect*
No
Yes
Cancer*
No
Yes

Year
Chemotherapy/ Radiation*
No
Yes
Taking blood thinners*
No
Yes
HIV/ Aids*
No
Yes
Keloids*
No
Yes
Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine*
No
Yes

If yes, please list

Any diseases or disorders not listed
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Photography Release Consent
 We would like your permission to use your photos for advert ising. For example, our studio portfolios, online and print adds, etc. Your consent is necessary regarding.*
No
Yes

Medical History 

Do you presently have or previously had any of the following 

Diabetes*
No
Yes
Insulin*
No
Yes
Hepatitis (A,B,C,D)*
No
Yes
Easy bleeding*
No
Yes
Chemical Peel*
No
Yes

last treatment
Pregnant now/ Breast feeding now*
No
Yes
Accutane or acne treatment*
No
Yes
Tan by booth or sun*
No
Yes
Difficulty numbing with dental work Aspirin, Ibuprofen, alcohol, ect*
No
Yes
Cancer*
No
Yes

Year
Chemotherapy/ Radiation*
No
Yes
Taking blood thinners*
No
Yes
HIV/ Aids*
No
Yes
Keloids*
No
Yes
Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine*
No
Yes

If yes, please list

Any diseases or disorders not listed
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Photography Release Consent
 We would like your permission to use your photos for advert ising. For example, our studio portfolios, online and print adds, etc. Your consent is necessary regarding.*
No
Yes

Medical History 

Do you presently have or previously had any of the following 

Diabetes*
No
Yes
Insulin*
No
Yes
Hepatitis (A,B,C,D)*
No
Yes
Easy bleeding*
No
Yes
Chemical Peel*
No
Yes

last treatment
Pregnant now/ Breast feeding now*
No
Yes
Accutane or acne treatment*
No
Yes
Tan by booth or sun*
No
Yes
Difficulty numbing with dental work Aspirin, Ibuprofen, alcohol, ect*
No
Yes
Cancer*
No
Yes

Year
Chemotherapy/ Radiation*
No
Yes
Taking blood thinners*
No
Yes
HIV/ Aids*
No
Yes
Keloids*
No
Yes
Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine*
No
Yes

If yes, please list

Any diseases or disorders not listed
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Photography Release Consent
 We would like your permission to use your photos for advert ising. For example, our studio portfolios, online and print adds, etc. Your consent is necessary regarding.*
No
Yes

Medical History 

Do you presently have or previously had any of the following 

Diabetes*
No
Yes
Insulin*
No
Yes
Hepatitis (A,B,C,D)*
No
Yes
Easy bleeding*
No
Yes
Chemical Peel*
No
Yes

last treatment
Pregnant now/ Breast feeding now*
No
Yes
Accutane or acne treatment*
No
Yes
Tan by booth or sun*
No
Yes
Difficulty numbing with dental work Aspirin, Ibuprofen, alcohol, ect*
No
Yes
Cancer*
No
Yes

Year
Chemotherapy/ Radiation*
No
Yes
Taking blood thinners*
No
Yes
HIV/ Aids*
No
Yes
Keloids*
No
Yes
Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine*
No
Yes

If yes, please list

Any diseases or disorders not listed
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Photography Release Consent
 We would like your permission to use your photos for advert ising. For example, our studio portfolios, online and print adds, etc. Your consent is necessary regarding.*
No
Yes

Medical History 

Do you presently have or previously had any of the following 

Diabetes*
No
Yes
Insulin*
No
Yes
Hepatitis (A,B,C,D)*
No
Yes
Easy bleeding*
No
Yes
Chemical Peel*
No
Yes

last treatment
Pregnant now/ Breast feeding now*
No
Yes
Accutane or acne treatment*
No
Yes
Tan by booth or sun*
No
Yes
Difficulty numbing with dental work Aspirin, Ibuprofen, alcohol, ect*
No
Yes
Cancer*
No
Yes

Year
Chemotherapy/ Radiation*
No
Yes
Taking blood thinners*
No
Yes
HIV/ Aids*
No
Yes
Keloids*
No
Yes
Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine*
No
Yes

If yes, please list

Any diseases or disorders not listed
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Photography Release Consent
 We would like your permission to use your photos for advert ising. For example, our studio portfolios, online and print adds, etc. Your consent is necessary regarding.*
No
Yes

Medical History 

Do you presently have or previously had any of the following 

Diabetes*
No
Yes
Insulin*
No
Yes
Hepatitis (A,B,C,D)*
No
Yes
Easy bleeding*
No
Yes
Chemical Peel*
No
Yes

last treatment
Pregnant now/ Breast feeding now*
No
Yes
Accutane or acne treatment*
No
Yes
Tan by booth or sun*
No
Yes
Difficulty numbing with dental work Aspirin, Ibuprofen, alcohol, ect*
No
Yes
Cancer*
No
Yes

Year
Chemotherapy/ Radiation*
No
Yes
Taking blood thinners*
No
Yes
HIV/ Aids*
No
Yes
Keloids*
No
Yes
Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine*
No
Yes

If yes, please list

Any diseases or disorders not listed
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Photography Release Consent
 We would like your permission to use your photos for advert ising. For example, our studio portfolios, online and print adds, etc. Your consent is necessary regarding.*
No
Yes

Medical History 

Do you presently have or previously had any of the following 

Diabetes*
No
Yes
Insulin*
No
Yes
Hepatitis (A,B,C,D)*
No
Yes
Easy bleeding*
No
Yes
Chemical Peel*
No
Yes

last treatment
Pregnant now/ Breast feeding now*
No
Yes
Accutane or acne treatment*
No
Yes
Tan by booth or sun*
No
Yes
Difficulty numbing with dental work Aspirin, Ibuprofen, alcohol, ect*
No
Yes
Cancer*
No
Yes

Year
Chemotherapy/ Radiation*
No
Yes
Taking blood thinners*
No
Yes
HIV/ Aids*
No
Yes
Keloids*
No
Yes
Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine*
No
Yes

If yes, please list

Any diseases or disorders not listed
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Photography Release Consent
 We would like your permission to use your photos for advert ising. For example, our studio portfolios, online and print adds, etc. Your consent is necessary regarding.*
No
Yes

Medical History 

Do you presently have or previously had any of the following 

Diabetes*
No
Yes
Insulin*
No
Yes
Hepatitis (A,B,C,D)*
No
Yes
Easy bleeding*
No
Yes
Chemical Peel*
No
Yes

last treatment
Pregnant now/ Breast feeding now*
No
Yes
Accutane or acne treatment*
No
Yes
Tan by booth or sun*
No
Yes
Difficulty numbing with dental work Aspirin, Ibuprofen, alcohol, ect*
No
Yes
Cancer*
No
Yes

Year
Chemotherapy/ Radiation*
No
Yes
Taking blood thinners*
No
Yes
HIV/ Aids*
No
Yes
Keloids*
No
Yes
Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine*
No
Yes

If yes, please list

Any diseases or disorders not listed
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 Information
Photography Release Consent
 We would like your permission to use your photos for advert ising. For example, our studio portfolios, online and print adds, etc. Your consent is necessary regarding.*
No
Yes

Medical History 

Do you presently have or previously had any of the following 

Diabetes*
No
Yes
Insulin*
No
Yes
Hepatitis (A,B,C,D)*
No
Yes
Easy bleeding*
No
Yes
Chemical Peel*
No
Yes

last treatment
Pregnant now/ Breast feeding now*
No
Yes
Accutane or acne treatment*
No
Yes
Tan by booth or sun*
No
Yes
Difficulty numbing with dental work Aspirin, Ibuprofen, alcohol, ect*
No
Yes
Cancer*
No
Yes

Year
Chemotherapy/ Radiation*
No
Yes
Taking blood thinners*
No
Yes
HIV/ Aids*
No
Yes
Keloids*
No
Yes
Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine*
No
Yes

If yes, please list

Any diseases or disorders not listed
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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