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PLEASE DONT FILL OUT WITHOUT MAKING AN APPOINTMENT FIRST

Luckys Cambridge Microblading Waiver and Questionnaire

Don't forget to bring government issued photo ID with you to your appointment, its required!

 

Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19 

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people 

Lucky’s Tattoo and Piercing have put in place preventative measures to reduce the spread of COVID-19; however, Lucky’s Tattoo and Piercing cannot guarantee that you will not become infected with COVID-19. Further, getting a tattoo or piercing could increase your risk of contracting COVID-19. 

---------------------------------------------

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by entering Lucky’s Tattoo and Piercing and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Lucky’s Tattoo and Piercing employees. 

I voluntarily agree to assume all of the possible risks and accept sole responsibility for any injury to myself (including, but not limited to, personal injury. disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my attendance at Lucky’s Tattoo and Piercing.

I hereby release, discharge, and hold harmless Lucky’s Tattoo and Piercing LLC,  its employees, agents, of and from the Claims, including all liabilities, claims, actions, damages, costs, or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of Lucky’s Tattoo and Piercing employees, agents, whether a COVID-19 infection occurs before, during, or after participation in any tattoo, piercing work, or any other services provided by Lucky’s Tattoo and Piercing LLC.

 

I Agree


CLIENT HEALTH QUESTIONNAIRE 
PRIOR TO THE START OF MY SERVICE, I CONFIRM THAT: 

 

I have not been diagnosed with or cared for someone diagnosed with COVID-19 in the past two weeks.

I Agree

I have not shown symptoms of COVID-19 or come in close contact with anyone exhibiting these symptoms in the past two weeks. 
I Agree

I have not traveled outside of my immediate daily routine for the past two weeks. 
I Agree

I do not have a cough, fever, chills, shortness of breath, or loss of taste or smell. 
I Agree

If I begin to show symptoms of COVID-19 within the next two weeks, I will contact Lucky's Tattoo and Piercing as soon as possible.
I Agree

I will follow all posted studio rules to keep myself, studio staff, and those around me safe. 
I Agree

 

 

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 on others.

Infection: Infection is very unusual. The areas treated must be kept clean, and only freshly cleaned hands should touch the areas. See the aftercare sheet for instruction on care.

Uneven Pigmentation: This can result from poor healing, infection, bleeding, or many other causes. 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.

Anesthetics: Topical anesthetics are used to numb the area to be tattooed. Lidocaine, Prilocaine, Benzocaine, Tetracaine, and/or Epinephrine cream and/or liquid are used. If you are allergic to any of these, please inform me now.

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.

The alternative to these possibilities is to use traditional cosmetics and NOT undergo the Semi-Permanent Eyebrow procedure.

Consent and release for procedures performed:

Statement of Consent and Recitals

Aftercare instructions have been explained to me and a written copy has been 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 the practitioner, Alicia Dane.


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


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


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


I understand that successful color saturation can NOT be guaranteed due to hidden scar tissue. 


I will tell all skincare professionals or medical personnel about my permanent makeup procedures, especially if I am scheduled for an MRI. 


I accept the responsibility to explain to you the desire for specific colors, shapes, and positions 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 60 days. 


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


I have been advised that a touch-up session is highly recommended to make any adjustments to shape, color, and to fill any pigment that may have had poor retention. Touch-ups must be completed within 60 days of initial procedure. 


I have been quoted the cost of today’s appointment which includes the touch-up. Touch- ups must be completed within 60 days of the initial procedure to be considered included. 


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). I have had the opportunity to ask questions, and all of my questions have been answered. I acknowledge that I have reviewed and approved the material given to me, and I authorize Alicia Dane, as my Eyebrow Microblading technician to perform on my body the 3D Eyebrow Microblading procedure desired today.

Today's Date: March 21, 2023

 

First Participant's Name

First Name*

Last Name*

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

Client Medical History 

Do you have or previously had any of the following?: (YES or NO 

Oily Skin*
No
Yes
History of MRSA*
No
Yes
Botox*
No
Yes

Last Treatement
Diabetes*
No
Yes
Hepatitis A B C D*
No
Yes
Easy Bleeding*
No
Yes
Abnormal Heart Condition*
No
Yes
Chemical Peel*
No
Yes

Last Treatment
Pregnant now - Breastfeeding now*
No
Yes
Brow Tinting*
No
Yes

Last brow tinting procedure done
Autoimmune disorder*
No
Yes
Cancer*
No
Yes

Year
Accutane or acne treatment*
No
Yes
Chemotherapy/ Radiation*
No
Yes
Currently tan by booth or salon*
No
Yes
Tumors/ Growth/ Cysts*
No
Yes
Difficulty numbing with dental work*
No
Yes
Taking blood thinners such as: Aspirin, Ibuprofen, Alcohol, Coumadin etc*
No
Yes
Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylene Glycol, Vitamin E Acetate, etc*
No
Yes

Please specify
Allergies to metals, food, etc*
No
Yes

Please specify
Any diseases or disorders not listed*
No
Yes

Please specify
Do you use skin care products containing Retin-A, Retinol, Glycolic Acid, or Alpha Hydroxyl?*
No
Yes
I agree that all the above information is true and accurate to the best of my knowledge*
No
Yes
First Participant's Signature*
Second Participant's Name

First Name*

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

Client Medical History 

Do you have or previously had any of the following?: (YES or NO 

Oily Skin*
No
Yes
History of MRSA*
No
Yes
Botox*
No
Yes

Last Treatement
Diabetes*
No
Yes
Hepatitis A B C D*
No
Yes
Easy Bleeding*
No
Yes
Abnormal Heart Condition*
No
Yes
Chemical Peel*
No
Yes

Last Treatment
Pregnant now - Breastfeeding now*
No
Yes
Brow Tinting*
No
Yes

Last brow tinting procedure done
Autoimmune disorder*
No
Yes
Cancer*
No
Yes

Year
Accutane or acne treatment*
No
Yes
Chemotherapy/ Radiation*
No
Yes
Currently tan by booth or salon*
No
Yes
Tumors/ Growth/ Cysts*
No
Yes
Difficulty numbing with dental work*
No
Yes
Taking blood thinners such as: Aspirin, Ibuprofen, Alcohol, Coumadin etc*
No
Yes
Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylene Glycol, Vitamin E Acetate, etc*
No
Yes

Please specify
Allergies to metals, food, etc*
No
Yes

Please specify
Any diseases or disorders not listed*
No
Yes

Please specify
Do you use skin care products containing Retin-A, Retinol, Glycolic Acid, or Alpha Hydroxyl?*
No
Yes
I agree that all the above information is true and accurate to the best of my knowledge*
No
Yes
Third Participant's Name

First Name*

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

Client Medical History 

Do you have or previously had any of the following?: (YES or NO 

Oily Skin*
No
Yes
History of MRSA*
No
Yes
Botox*
No
Yes

Last Treatement
Diabetes*
No
Yes
Hepatitis A B C D*
No
Yes
Easy Bleeding*
No
Yes
Abnormal Heart Condition*
No
Yes
Chemical Peel*
No
Yes

Last Treatment
Pregnant now - Breastfeeding now*
No
Yes
Brow Tinting*
No
Yes

Last brow tinting procedure done
Autoimmune disorder*
No
Yes
Cancer*
No
Yes

Year
Accutane or acne treatment*
No
Yes
Chemotherapy/ Radiation*
No
Yes
Currently tan by booth or salon*
No
Yes
Tumors/ Growth/ Cysts*
No
Yes
Difficulty numbing with dental work*
No
Yes
Taking blood thinners such as: Aspirin, Ibuprofen, Alcohol, Coumadin etc*
No
Yes
Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylene Glycol, Vitamin E Acetate, etc*
No
Yes

Please specify
Allergies to metals, food, etc*
No
Yes

Please specify
Any diseases or disorders not listed*
No
Yes

Please specify
Do you use skin care products containing Retin-A, Retinol, Glycolic Acid, or Alpha Hydroxyl?*
No
Yes
I agree that all the above information is true and accurate to the best of my knowledge*
No
Yes
Fourth Participant's Name

First Name*

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

Client Medical History 

Do you have or previously had any of the following?: (YES or NO 

Oily Skin*
No
Yes
History of MRSA*
No
Yes
Botox*
No
Yes

Last Treatement
Diabetes*
No
Yes
Hepatitis A B C D*
No
Yes
Easy Bleeding*
No
Yes
Abnormal Heart Condition*
No
Yes
Chemical Peel*
No
Yes

Last Treatment
Pregnant now - Breastfeeding now*
No
Yes
Brow Tinting*
No
Yes

Last brow tinting procedure done
Autoimmune disorder*
No
Yes
Cancer*
No
Yes

Year
Accutane or acne treatment*
No
Yes
Chemotherapy/ Radiation*
No
Yes
Currently tan by booth or salon*
No
Yes
Tumors/ Growth/ Cysts*
No
Yes
Difficulty numbing with dental work*
No
Yes
Taking blood thinners such as: Aspirin, Ibuprofen, Alcohol, Coumadin etc*
No
Yes
Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylene Glycol, Vitamin E Acetate, etc*
No
Yes

Please specify
Allergies to metals, food, etc*
No
Yes

Please specify
Any diseases or disorders not listed*
No
Yes

Please specify
Do you use skin care products containing Retin-A, Retinol, Glycolic Acid, or Alpha Hydroxyl?*
No
Yes
I agree that all the above information is true and accurate to the best of my knowledge*
No
Yes
Fifth Participant's Name

First Name*

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

Client Medical History 

Do you have or previously had any of the following?: (YES or NO 

Oily Skin*
No
Yes
History of MRSA*
No
Yes
Botox*
No
Yes

Last Treatement
Diabetes*
No
Yes
Hepatitis A B C D*
No
Yes
Easy Bleeding*
No
Yes
Abnormal Heart Condition*
No
Yes
Chemical Peel*
No
Yes

Last Treatment
Pregnant now - Breastfeeding now*
No
Yes
Brow Tinting*
No
Yes

Last brow tinting procedure done
Autoimmune disorder*
No
Yes
Cancer*
No
Yes

Year
Accutane or acne treatment*
No
Yes
Chemotherapy/ Radiation*
No
Yes
Currently tan by booth or salon*
No
Yes
Tumors/ Growth/ Cysts*
No
Yes
Difficulty numbing with dental work*
No
Yes
Taking blood thinners such as: Aspirin, Ibuprofen, Alcohol, Coumadin etc*
No
Yes
Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylene Glycol, Vitamin E Acetate, etc*
No
Yes

Please specify
Allergies to metals, food, etc*
No
Yes

Please specify
Any diseases or disorders not listed*
No
Yes

Please specify
Do you use skin care products containing Retin-A, Retinol, Glycolic Acid, or Alpha Hydroxyl?*
No
Yes
I agree that all the above information is true and accurate to the best of my knowledge*
No
Yes
Sixth Participant's Name

First Name*

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

Client Medical History 

Do you have or previously had any of the following?: (YES or NO 

Oily Skin*
No
Yes
History of MRSA*
No
Yes
Botox*
No
Yes

Last Treatement
Diabetes*
No
Yes
Hepatitis A B C D*
No
Yes
Easy Bleeding*
No
Yes
Abnormal Heart Condition*
No
Yes
Chemical Peel*
No
Yes

Last Treatment
Pregnant now - Breastfeeding now*
No
Yes
Brow Tinting*
No
Yes

Last brow tinting procedure done
Autoimmune disorder*
No
Yes
Cancer*
No
Yes

Year
Accutane or acne treatment*
No
Yes
Chemotherapy/ Radiation*
No
Yes
Currently tan by booth or salon*
No
Yes
Tumors/ Growth/ Cysts*
No
Yes
Difficulty numbing with dental work*
No
Yes
Taking blood thinners such as: Aspirin, Ibuprofen, Alcohol, Coumadin etc*
No
Yes
Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylene Glycol, Vitamin E Acetate, etc*
No
Yes

Please specify
Allergies to metals, food, etc*
No
Yes

Please specify
Any diseases or disorders not listed*
No
Yes

Please specify
Do you use skin care products containing Retin-A, Retinol, Glycolic Acid, or Alpha Hydroxyl?*
No
Yes
I agree that all the above information is true and accurate to the best of my knowledge*
No
Yes
Seventh Participant's Name

First Name*

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

Client Medical History 

Do you have or previously had any of the following?: (YES or NO 

Oily Skin*
No
Yes
History of MRSA*
No
Yes
Botox*
No
Yes

Last Treatement
Diabetes*
No
Yes
Hepatitis A B C D*
No
Yes
Easy Bleeding*
No
Yes
Abnormal Heart Condition*
No
Yes
Chemical Peel*
No
Yes

Last Treatment
Pregnant now - Breastfeeding now*
No
Yes
Brow Tinting*
No
Yes

Last brow tinting procedure done
Autoimmune disorder*
No
Yes
Cancer*
No
Yes

Year
Accutane or acne treatment*
No
Yes
Chemotherapy/ Radiation*
No
Yes
Currently tan by booth or salon*
No
Yes
Tumors/ Growth/ Cysts*
No
Yes
Difficulty numbing with dental work*
No
Yes
Taking blood thinners such as: Aspirin, Ibuprofen, Alcohol, Coumadin etc*
No
Yes
Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylene Glycol, Vitamin E Acetate, etc*
No
Yes

Please specify
Allergies to metals, food, etc*
No
Yes

Please specify
Any diseases or disorders not listed*
No
Yes

Please specify
Do you use skin care products containing Retin-A, Retinol, Glycolic Acid, or Alpha Hydroxyl?*
No
Yes
I agree that all the above information is true and accurate to the best of my knowledge*
No
Yes
Eighth Participant's Name

First Name*

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

Client Medical History 

Do you have or previously had any of the following?: (YES or NO 

Oily Skin*
No
Yes
History of MRSA*
No
Yes
Botox*
No
Yes

Last Treatement
Diabetes*
No
Yes
Hepatitis A B C D*
No
Yes
Easy Bleeding*
No
Yes
Abnormal Heart Condition*
No
Yes
Chemical Peel*
No
Yes

Last Treatment
Pregnant now - Breastfeeding now*
No
Yes
Brow Tinting*
No
Yes

Last brow tinting procedure done
Autoimmune disorder*
No
Yes
Cancer*
No
Yes

Year
Accutane or acne treatment*
No
Yes
Chemotherapy/ Radiation*
No
Yes
Currently tan by booth or salon*
No
Yes
Tumors/ Growth/ Cysts*
No
Yes
Difficulty numbing with dental work*
No
Yes
Taking blood thinners such as: Aspirin, Ibuprofen, Alcohol, Coumadin etc*
No
Yes
Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylene Glycol, Vitamin E Acetate, etc*
No
Yes

Please specify
Allergies to metals, food, etc*
No
Yes

Please specify
Any diseases or disorders not listed*
No
Yes

Please specify
Do you use skin care products containing Retin-A, Retinol, Glycolic Acid, or Alpha Hydroxyl?*
No
Yes
I agree that all the above information is true and accurate to the best of my knowledge*
No
Yes
Ninth Participant's Name

First Name*

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

Client Medical History 

Do you have or previously had any of the following?: (YES or NO 

Oily Skin*
No
Yes
History of MRSA*
No
Yes
Botox*
No
Yes

Last Treatement
Diabetes*
No
Yes
Hepatitis A B C D*
No
Yes
Easy Bleeding*
No
Yes
Abnormal Heart Condition*
No
Yes
Chemical Peel*
No
Yes

Last Treatment
Pregnant now - Breastfeeding now*
No
Yes
Brow Tinting*
No
Yes

Last brow tinting procedure done
Autoimmune disorder*
No
Yes
Cancer*
No
Yes

Year
Accutane or acne treatment*
No
Yes
Chemotherapy/ Radiation*
No
Yes
Currently tan by booth or salon*
No
Yes
Tumors/ Growth/ Cysts*
No
Yes
Difficulty numbing with dental work*
No
Yes
Taking blood thinners such as: Aspirin, Ibuprofen, Alcohol, Coumadin etc*
No
Yes
Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylene Glycol, Vitamin E Acetate, etc*
No
Yes

Please specify
Allergies to metals, food, etc*
No
Yes

Please specify
Any diseases or disorders not listed*
No
Yes

Please specify
Do you use skin care products containing Retin-A, Retinol, Glycolic Acid, or Alpha Hydroxyl?*
No
Yes
I agree that all the above information is true and accurate to the best of my knowledge*
No
Yes
Tenth Participant's Name

First Name*

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

Client Medical History 

Do you have or previously had any of the following?: (YES or NO 

Oily Skin*
No
Yes
History of MRSA*
No
Yes
Botox*
No
Yes

Last Treatement
Diabetes*
No
Yes
Hepatitis A B C D*
No
Yes
Easy Bleeding*
No
Yes
Abnormal Heart Condition*
No
Yes
Chemical Peel*
No
Yes

Last Treatment
Pregnant now - Breastfeeding now*
No
Yes
Brow Tinting*
No
Yes

Last brow tinting procedure done
Autoimmune disorder*
No
Yes
Cancer*
No
Yes

Year
Accutane or acne treatment*
No
Yes
Chemotherapy/ Radiation*
No
Yes
Currently tan by booth or salon*
No
Yes
Tumors/ Growth/ Cysts*
No
Yes
Difficulty numbing with dental work*
No
Yes
Taking blood thinners such as: Aspirin, Ibuprofen, Alcohol, Coumadin etc*
No
Yes
Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylene Glycol, Vitamin E Acetate, etc*
No
Yes

Please specify
Allergies to metals, food, etc*
No
Yes

Please specify
Any diseases or disorders not listed*
No
Yes

Please specify
Do you use skin care products containing Retin-A, Retinol, Glycolic Acid, or Alpha Hydroxyl?*
No
Yes
I agree that all the above information is true and accurate to the best of my knowledge*
No
Yes
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.
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.


By signing below the parent or court-appointed legal guardian agrees that they are also 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

Client Medical History 

Do you have or previously had any of the following?: (YES or NO 

Oily Skin*
No
Yes
History of MRSA*
No
Yes
Botox*
No
Yes

Last Treatement
Diabetes*
No
Yes
Hepatitis A B C D*
No
Yes
Easy Bleeding*
No
Yes
Abnormal Heart Condition*
No
Yes
Chemical Peel*
No
Yes

Last Treatment
Pregnant now - Breastfeeding now*
No
Yes
Brow Tinting*
No
Yes

Last brow tinting procedure done
Autoimmune disorder*
No
Yes
Cancer*
No
Yes

Year
Accutane or acne treatment*
No
Yes
Chemotherapy/ Radiation*
No
Yes
Currently tan by booth or salon*
No
Yes
Tumors/ Growth/ Cysts*
No
Yes
Difficulty numbing with dental work*
No
Yes
Taking blood thinners such as: Aspirin, Ibuprofen, Alcohol, Coumadin etc*
No
Yes
Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylene Glycol, Vitamin E Acetate, etc*
No
Yes

Please specify
Allergies to metals, food, etc*
No
Yes

Please specify
Any diseases or disorders not listed*
No
Yes

Please specify
Do you use skin care products containing Retin-A, Retinol, Glycolic Acid, or Alpha Hydroxyl?*
No
Yes
I agree that all the above information is true and accurate to the best of my knowledge*
No
Yes
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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