Privacy Policy 

Effective date: Sept 2nd, 2020

Also pertain to our website 

Renlysa Artistry LLC. ("us", "we", or "our") operates the https://renlysaartistry.com/ website (hereinafter referred to as the "Service").

This page informs you of our policies regarding the collection, use and disclosure of personal data when you use our Service and the choices you have associated with that data.

We use your data to provide and improve the Service. By using the Service, you agree to the collection and use of information in accordance with this policy. Unless otherwise defined in this Privacy Policy, the terms used in this Privacy Policy have the same meanings as in our Terms and Conditions, accessible from https://renlysaartistry.com

Definitions

Service

Service is the https://renlysaartistry.com/ website operated by Renlysa Artistry LLC

Personal Data

Personal Data means data about a living individual who can be identified from those data (or from those and other information either in our possession or likely to come into our possession).

Usage Data

Usage Data is data collected automatically either generated by the use of the Service or from the Service infrastructure itself (for example, the duration of a page visit).

Cookies

Cookies are small files stored on your device (computer or mobile device).

Data Controller

Data Controller means the natural or legal person who (either alone or jointly or in common with other persons) determines the purposes for which and the manner in which any personal information are, or are to be, processed.

For the purpose of this Privacy Policy, we are a Data Controller of your Personal Data.

Data Processors (or Service Providers)

Data Processor (or Service Provider) means any natural or legal person who processes the data on behalf of the Data Controller.

We may use the services of various Service Providers in order to process your data more effectively.

Data Subject (or User)

Data Subject is any living individual who is using our Service and is the subject of Personal Data.

Information Collection and Use

We collect several different types of information for various purposes to provide and improve our Service to you.

Types of Data Collected
Personal Data

While using our Service, we may ask you to provide us with certain personally identifiable information that can be used to contact or identify you ("Personal Data"). Personally identifiable information may include, but is not limited to:

Email address
First name and last name
Phone number
Address, State, Province, ZIP/Postal code, City
Cookies and Usage Data

We may use your Personal Data to contact you with newsletters, marketing or promotional materials and other information that may be of interest to you. You may opt out of receiving any, or all, of these communications from us by following the unsubscribe link or the instructions provided in any email we send.

Usage Data

We may also collect information on how the Service is accessed and used ("Usage Data"). This Usage Data may include information such as your computer's Internet Protocol address (e.g. IP address), browser type, browser version, the pages of our Service that you visit, the time and date of your visit, the time spent on those pages, unique device identifiers and other diagnostic data.

Location Data

We may use and store information about your location if you give us permission to do so ("Location Data"). We use this data to provide features of our Service, to improve and customise our Service.

You can enable or disable location services when you use our Service at any time by way of your device settings.

Tracking & Cookies Data

We use cookies and similar tracking technologies to track the activity on our Service and we hold certain information.

Cookies are filed with a small amount of data which may include an anonymous unique identifier. Cookies are sent to your browser from a website and stored on your device. Other tracking technologies are also used such as beacons, tags and scripts to collect and track information and to improve and analyse our Service.

You can instruct your browser to refuse all cookies or to indicate when a cookie is being sent. However, if you do not accept cookies, you may not be able to use some portions of our Service.

Examples of Cookies we use:

Session Cookies. We use Session Cookies to operate our Service.
Preference Cookies. We use Preference Cookies to remember your preferences and various settings.
Security Cookies. We use Security Cookies for security purposes.

Use of Data

Renlysa Artistry LLC. uses the collected data for various purposes:

To provide and maintain our Service
To notify you about changes to our Service
To allow you to participate in interactive features of our Service when you choose to do so
To provide customer support
To gather analysis or valuable information so that we can improve our Service
To monitor the usage of our Service
To detect, prevent and address technical issues
To provide you with news, special offers and general information about other goods, services and events which we offer that are similar to those that you have already purchased or enquired about unless you have opted not to receive such information

Legal Basis for Processing Personal Data under the General Data Protection Regulation (GDPR)

If you are from the European Economic Area (EEA), Renlysa Artistry LLC. legal basis for collecting and using the personal information described in this Privacy Policy depends on the Personal Data we collect and the specific context in which we collect it.

Renlysa Artistry LLC. may process your Personal Data because:

We need to perform a contract with you
You have given us permission to do so
The processing is in our legitimate interests and it is not overridden by your rights
For payment processing purposes
To comply with the law

Retention of Data

Renlysa Artistry LLC will retain your Personal Data only for as long as is necessary for the purposes set out in this Privacy Policy. We will retain and use your Personal Data to the extent necessary to comply with our legal obligations (for example, if we are required to retain your data to comply with applicable laws), resolve disputes and enforce our legal agreements and policies.

Renlysa Artistry LLC. will also retain Usage Data for internal analysis purposes. Usage Data is generally retained for a shorter period of time, except when this data is used to strengthen the security or to improve the functionality of our Service, or we are legally obligated to retain this data for longer periods.

Transfer of Data

Your information, including Personal Data, may be transferred to - and maintained on - computers located outside of your state, province, country or other governmental jurisdiction where the data protection laws may differ from those of your jurisdiction.

If you are located outside United States and choose to provide information to us, please note that we transfer the data, including Personal Data, to United States and process it there.

Your consent to this Privacy Policy followed by your submission of such information represents your agreement to that transfer.

Renlysa Artistry LLC. will take all the steps reasonably necessary to ensure that your data is treated securely and in accordance with this Privacy Policy and no transfer of your Personal Data will take place to an organisation or a country unless there are adequate controls in place including the security of your data and other personal information.

Disclosure of Data
Business Transaction

If Renlysa Artistry LLC. is involved in a merger, acquisition or asset sale, your Personal Data may be transferred. We will provide notice before your Personal Data is transferred and becomes subject to a different Privacy Policy.

Disclosure for Law Enforcement

Under certain circumstances, Renlysa Artistry LLC. may be required to disclose your Personal Data if required to do so by law or in response to valid requests by public authorities (e.g. a court or a government agency).

Legal Requirements

Renlysa Artistry LLC. may disclose your Personal Data in the good faith belief that such action is necessary to:

To comply with a legal obligation
To protect and defend the rights or property of Renlysa Artistry LLC.
To prevent or investigate possible wrongdoing in connection with the Service
To protect the personal safety of users of the Service or the public
To protect against legal liability

Security of Data

The security of your data is important to us but remember that no method of transmission over the Internet or method of electronic storage is 100% secure. While we strive to use commercially acceptable means to protect your Personal Data, we cannot guarantee its absolute security.

Our Policy on "Do Not Track" Signals under the California Online Protection Act (CalOPPA)

We do not support Do Not Track ("DNT"). Do Not Track is a preference you can set in your web browser to inform websites that you do not want to be tracked.

You can enable or disable Do Not Track by visiting the Preferences or Settings page of your web browser.

Your Data Protection Rights under the General Data Protection Regulation (GDPR)

If you are a resident of the European Economic Area (EEA), you have certain data protection rights. Eve Beauty Inc. aims to take reasonable steps to allow you to correct, amend, delete or limit the use of your Personal Data.

If you wish to be informed about what Personal Data we hold about you and if you want it to be removed from our systems, please contact us.

In certain circumstances, you have the following data protection rights:

The right to access, update or delete the information we have on you. Whenever made possible, you can access, update or request deletion of your Personal Data directly within your account settings section. If you are unable to perform these actions yourself, please contact us to assist you.

The right of rectification. You have the right to have your information rectified if that information is inaccurate or incomplete.

The right to object. You have the right to object to our processing of your Personal Data.

The right of restriction. You have the right to request that we restrict the processing of your personal information.

The right to data portability. You have the right to be provided with a copy of the information we have on you in a structured, machine-readable and commonly used format.

The right to withdraw consent. You also have the right to withdraw your consent at any time where Renlysa Artistry LLC relied on your consent to process your personal information.

Please note that we may ask you to verify your identity before responding to such requests.

You have the right to complain to a Data Protection Authority about our collection and use of your Personal Data. For more information, please contact your local data protection authority in the European Economic Area (EEA).

Service Providers

We may employ third party companies and individuals to facilitate our Service ("Service Providers"), provide the Service on our behalf, perform Service-related services or assist us in analysing how our Service is used.

These third parties have access to your Personal Data only to perform these tasks on our behalf and are obligated not to disclose or use it for any other purpose.

Analytics

We may use third-party Service Providers to monitor and analyse the use of our Service.

Google Analytics

Google Analytics is a web analytics service offered by Google that tracks and reports website traffic. Google uses the data collected to track and monitor the use of our Service. This data is shared with other Google services. Google may use the collected data to contextualise and personalise the ads of its own advertising network.

You can opt-out of having made your activity on the Service available to Google Analytics by installing the Google Analytics opt-out browser add-on. The add-on prevents the Google Analytics JavaScript (ga.js, analytics.js and dc.js) from sharing information with Google Analytics about visits activity.

For more information on the privacy practices of Google, please visit the Google Privacy & Terms web page: https://policies.google.com/privacy?hl=en

Behavioral Remarketing

Renlysa Artistry LLC uses remarketing services to advertise on third party websites to you after you visited our Service. We and our third-party vendors use cookies to inform, optimise and serve ads based on your past visits to our Service.

Facebook

Facebook remarketing service is provided by Facebook Inc.

You can learn more about interest-based advertising from Facebook by visiting this page: https://www.facebook.com/help/164968693837950

To opt-out from Facebook's interest-based ads, follow these instructions from Facebook: https://www.facebook.com/help/568137493302217

Facebook adheres to the Self-Regulatory Principles for Online Behavioural Advertising established by the Digital Advertising Alliance. You can also opt-out from Facebook and other participating companies through the Digital Advertising Alliance in the USA http://www.aboutads.info/choices/, the Digital Advertising Alliance of Canada in Canada http://youradchoices.ca/ or the European Interactive Digital Advertising Alliance in Europe http://www.youronlinechoices.eu/, or opt-out using your mobile device settings.

For more information on the privacy practices of Facebook, please visit Facebook's Data Policy: https://www.facebook.com/privacy/explanation

Payments

We may provide paid products and/or services within the Service. In that case, we use third-party services for payment processing (e.g. payment processors).

We will not store or collect your payment card details. That information is provided directly to our third-party payment processors whose use of your personal information is governed by their Privacy Policy. These payment processors adhere to the standards set by PCI-DSS as managed by the PCI Security Standards Council, which is a joint effort of brands like Visa, MasterCard, American Express and Discover. PCI-DSS requirements help ensure the secure handling of payment information.

The payment processors we work with are:

Fresha

Their Privacy Policy can be viewed at 

https://www.fresha.com/docs/legal-clauses-privacy.pdf

PayPal 

Their Privacy Policy can be viewed at https://www.paypal.com/webapps/mpp/ua/privacy-full

Smartwaiver

Their privacy policy can be view at 

https://www.smartwaiver.com/privacy

Links to Other Sites

Our Service may contain links to other sites that are not operated by us. If you click a third party link, you will be directed to that third party's site. We strongly advise you to review the Privacy Policy of every site you visit.

We have no control over and assume no responsibility for the content, privacy policies or practices of any third party sites or services.

Children's Privacy

Our Service does not address anyone under the age of 18 ("Children").

We do not knowingly collect personally identifiable information from anyone under the age of 18. If you are a parent or guardian and you are aware that your Child has provided us with Personal Data, please contact us. If we become aware that we have collected Personal Data from children without verification of parental consent, we take steps to remove that information from our servers.

Changes to This Privacy Policy

We may update our Privacy Policy from time to time. We will notify you of any changes by posting the new Privacy Policy on this page.

We will let you know via email and/or a prominent notice on our Service, prior to the change becoming effective and update the "effective date" at the top of this Privacy Policy.

You are advised to review this Privacy Policy periodically for any changes. Changes to this Privacy Policy are effective when they are posted on this page.

Contact Us

If you have any questions about this Privacy Policy, please contact us:

By email: Renlysaartistry@gmail.com
By visiting this page on our website: https://renlysaartistry.com/contact

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Renlysa Artistry Consent Forms
 


Review Renlysa Artistry Privacy Policy

PERMANENT MAKEUP PROCEDURE AND MEDICAL HISTORY

I am over the age of 18, am not under the influence of drugs or alcohol, am not pregnant or nursing and desire to receive the indicated permanent cosmetic procedure. The general nature of cosmetic tattooing as well as the specific procedure to be performed has been explained to me.

I have been informed of the nature, risks, and possible complications and consequences of permanent skin pigmentation. I understand the permanent skin pigmentation procedure carries with it known and unknown complications and consequences associated with this type of cosmetic procedure, including, but not limited to: infections, scarring, inconsistent color, flares, and spreading, fanning or fading of pigments. Corneal abrasions are a rare side effect, especially if I rub or scratch my eyes or apply contacts too soon after any eyeliner procedure. I understand the actual color of the pigment maybe modified slightly, due to the tone and color of my skin. I fully understand this is a tattoo process and therefore not an exact science, but an art. I request the permanent skin pigmentation procedure(s) of the said procedure(s).

There is a possibility of an allergic reaction to pigments, anesthetics, and other materials use. A patch test is advisable, however, it does not ensure a client will not have an allergic reaction. If waived, I release the technician from liability if I develop an allergic reaction to all materials used. 

I understand the usual risks inherent in the procedure and the possibility of complications during and following its performance. I understand there may be a certain amount of pain associated with the procedure and that other adverse side effects may include minor and temporary bleeding, bruising, redness or other discoloration and swelling. Fever blisters may occur on the lips following lip procedures on individuals prone to this problem. Fading or loss of pigment may occur. Secondary infections in the procedure area rarely occurs. 

I Understand that 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. Generally, infection are unusual, the area must be kept clean and following strict aftercare provided by my technician.

I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse change to my permanent cosmetics. I acknowledge some of these potential adverse changes may not be correctable. 

Depending on the procedure(s) which I select, I accept responsibility for determining the color, shape, symmetry, and position of the eyebrows, eyeliner, lips, and/or the color of camouflage.

I have received pre and post procedure instructions and I will strictly adhere to such instructions. I understand that my failure to do so may jeopardize my chances for a successful procedure. If I am on any medication for depression or any other mood altering prescription, I will advise my technician if I have ever had cold sores I will consult with and strictly follow my doctor’s instructions before contemplating any permanent cosmetic procedure around my lips. 

I understand that I have notified my technician that I am currently using eyelash growth serum and it may cause excessive bleeding during eyeliner procedure.

I understand and accept that the PMU procedure is a process, often requiring multiple applications of color to achieve desirable results.

I understand this procedure will result in a permanent change to my appearance. 

I understand that the taking of before and after photographs of the said procedure(s) are a condition of such procedure(s) and might be used for educational purposes and/or published online on our business website and social media accounts. I certify I have read and initialed the above paragraphs and have had explained to my understanding this consent and procedure permit. I accept full responsibility for the decision to have this cosmetic tattoo work done. 

If you are a candidate for Microblading/Permanent Makeup, please note:

  • Read all the precare on the website at www.renlysaartistry.com/book-now 
  • Do not take Aspirin, Mulit-vitamins containing Niacin, fish oils, Vitamin E and/or
  • Do not take Ibuprofen or any pain killers unless medically necessary on the day of procedure and 1- 3 days before your procedure. Tylenol is fine.
  • Do not use skincare products contain active ingredients or any type of acids/exfoliants on your face 1 week prior. 
  • Stop using Lash growth serum 1 week prior to eyeliner tattoo procedure
  • Start taking coldsore medication 5 days prior to Lip tattoo procedure and continue until lips are healed.
  • If you use Accutane, you must be off Accutane for 1 year, NO EXCEPTIONS!
  • Do not consume alcohol, caffeine, or cannabis the day before and day of Procedure.
  • Avoid working out or sweating excessively right before and 10 days after procedure
  • If you get your eyebrows waxed or tinted, it is recommended to wait at least 3 days before the procedure.
  • Antacids, High blood pressure, thyroid and anxiety medications have been reported as interfering with retention or shifting the pigments to an undesirable tone.
  • PLEASE NOTIFY US IF YOU HAVE OR PLAN TO BE VACCINATED WITH THE COVID-19 VACCINATION. WE HAVE BEEN ADVISED BY THE AAM PMU BOARD TO HALT ON PMU PROCEDURES IN BETWEEN SHOTS, AWAITING 10-14 DAYS AFTER SECOND SHOT TO PERFORM PMU PROCEDURES.

 

PRECAUTIONARY CORONAVIRUS LIABILITY RELEASE FORM

Due to the 2019-2020 outbreak of the novel Coronavirus, COVID-19, we are taking extra precautions with the intake of each client, health history review, as well as sanitation and disinfecting practices. Please complete the following and sign below.

Symptoms of COVID-19 include:

  • Fever
  • Fatigue
  • Dry Cough
  • Difficulty Breathing
  • Diarrhea
  • No sense of taste and smell 
  • Headache/Migraine 
  • body soreness

I agree to the following:

I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 14 days. 

I Agree

I affirm that I, as well as all household members, have not been diagnosed with COVID-19 within 30 days. 

I Agree

I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the last 30 days. 

I Agree

I affirm that I, as well as all household members, have not traveled outside of the United States or to any state or city outside of our own that is or has been considered a “hot spot” for COVID-19 infections within the last 30 days. 

I Agree

I understand that Renlysa Artistry can not be held liable for any exposure to the virus or any other contagion caused by misinformation on this form or the health history provided by each client.

I Agree

I understand that Renlysa Artistry can not be held liable for any side effects that may or may not be caused by the COVID 19 vaccination due to it being new and still too many unknowns about the effects of the vaccine and PMU.

I Agree

By signing below I agree to each above statement and release Renlysa Artistry and their team from any and all liability for the unintentional exposure or harm due to COVID-19.

Your permanent makeup artist and all employees of this facility agree that they abide by these same standards and affirm the same. We also affirm that we have improved and expanded our sanitation protocols to more thoroughly fight the spread of COVID-19 and other communicable conditions.

Today's Date: December 6, 2022

First Client's Name

First Name*

Last Name*

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

PROCEDURE TYPE

COST OF PROCEDURE(s)
Please check any of the following medical conditions that apply: *
"Dry eye"
(HSV) Cold sores
ALL Hepatitis
Allergies
Alopecia
Autoimmune
Cancer(Any type)/Treatment
Cataracts
Corneal abrasions
Currently wearing contact lenses
Diabetes
Easily bruised
Excessive bleeding
Eye surgery or injury
Fever blisters/Herpes
Heart problems
High blood pressure
HIV/Aids
Keloid scars
Pregnant/Nursing
Skin Rashes(Ringworm, Psoriasis, Severe Rosacea, Eczema, Dermatitis etc)
Thyroid disease
(NONE OF THE ABOVE APPLY)

If you selected yes to any of the above, please specify in detail and fully understand you WILL be asked to request a letter of clearance from your doctor(HEALTH DEPARTMENT REQUIREMENT) before booking a procedure:

List all medications you are currently taking:

Physician Contact info:
First Client's Signature*
Second Client's Name

First Name*

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

PROCEDURE TYPE

COST OF PROCEDURE(s)
Please check any of the following medical conditions that apply: *
"Dry eye"
(HSV) Cold sores
ALL Hepatitis
Allergies
Alopecia
Autoimmune
Cancer(Any type)/Treatment
Cataracts
Corneal abrasions
Currently wearing contact lenses
Diabetes
Easily bruised
Excessive bleeding
Eye surgery or injury
Fever blisters/Herpes
Heart problems
High blood pressure
HIV/Aids
Keloid scars
Pregnant/Nursing
Skin Rashes(Ringworm, Psoriasis, Severe Rosacea, Eczema, Dermatitis etc)
Thyroid disease
(NONE OF THE ABOVE APPLY)

If you selected yes to any of the above, please specify in detail and fully understand you WILL be asked to request a letter of clearance from your doctor(HEALTH DEPARTMENT REQUIREMENT) before booking a procedure:

List all medications you are currently taking:

Physician Contact info:
Third Client's Name

First Name*

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

PROCEDURE TYPE

COST OF PROCEDURE(s)
Please check any of the following medical conditions that apply: *
"Dry eye"
(HSV) Cold sores
ALL Hepatitis
Allergies
Alopecia
Autoimmune
Cancer(Any type)/Treatment
Cataracts
Corneal abrasions
Currently wearing contact lenses
Diabetes
Easily bruised
Excessive bleeding
Eye surgery or injury
Fever blisters/Herpes
Heart problems
High blood pressure
HIV/Aids
Keloid scars
Pregnant/Nursing
Skin Rashes(Ringworm, Psoriasis, Severe Rosacea, Eczema, Dermatitis etc)
Thyroid disease
(NONE OF THE ABOVE APPLY)

If you selected yes to any of the above, please specify in detail and fully understand you WILL be asked to request a letter of clearance from your doctor(HEALTH DEPARTMENT REQUIREMENT) before booking a procedure:

List all medications you are currently taking:

Physician Contact info:
Fourth Client's Name

First Name*

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

PROCEDURE TYPE

COST OF PROCEDURE(s)
Please check any of the following medical conditions that apply: *
"Dry eye"
(HSV) Cold sores
ALL Hepatitis
Allergies
Alopecia
Autoimmune
Cancer(Any type)/Treatment
Cataracts
Corneal abrasions
Currently wearing contact lenses
Diabetes
Easily bruised
Excessive bleeding
Eye surgery or injury
Fever blisters/Herpes
Heart problems
High blood pressure
HIV/Aids
Keloid scars
Pregnant/Nursing
Skin Rashes(Ringworm, Psoriasis, Severe Rosacea, Eczema, Dermatitis etc)
Thyroid disease
(NONE OF THE ABOVE APPLY)

If you selected yes to any of the above, please specify in detail and fully understand you WILL be asked to request a letter of clearance from your doctor(HEALTH DEPARTMENT REQUIREMENT) before booking a procedure:

List all medications you are currently taking:

Physician Contact info:
Fifth Client's Name

First Name*

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

PROCEDURE TYPE

COST OF PROCEDURE(s)
Please check any of the following medical conditions that apply: *
"Dry eye"
(HSV) Cold sores
ALL Hepatitis
Allergies
Alopecia
Autoimmune
Cancer(Any type)/Treatment
Cataracts
Corneal abrasions
Currently wearing contact lenses
Diabetes
Easily bruised
Excessive bleeding
Eye surgery or injury
Fever blisters/Herpes
Heart problems
High blood pressure
HIV/Aids
Keloid scars
Pregnant/Nursing
Skin Rashes(Ringworm, Psoriasis, Severe Rosacea, Eczema, Dermatitis etc)
Thyroid disease
(NONE OF THE ABOVE APPLY)

If you selected yes to any of the above, please specify in detail and fully understand you WILL be asked to request a letter of clearance from your doctor(HEALTH DEPARTMENT REQUIREMENT) before booking a procedure:

List all medications you are currently taking:

Physician Contact info:
Sixth Client's Name

First Name*

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

PROCEDURE TYPE

COST OF PROCEDURE(s)
Please check any of the following medical conditions that apply: *
"Dry eye"
(HSV) Cold sores
ALL Hepatitis
Allergies
Alopecia
Autoimmune
Cancer(Any type)/Treatment
Cataracts
Corneal abrasions
Currently wearing contact lenses
Diabetes
Easily bruised
Excessive bleeding
Eye surgery or injury
Fever blisters/Herpes
Heart problems
High blood pressure
HIV/Aids
Keloid scars
Pregnant/Nursing
Skin Rashes(Ringworm, Psoriasis, Severe Rosacea, Eczema, Dermatitis etc)
Thyroid disease
(NONE OF THE ABOVE APPLY)

If you selected yes to any of the above, please specify in detail and fully understand you WILL be asked to request a letter of clearance from your doctor(HEALTH DEPARTMENT REQUIREMENT) before booking a procedure:

List all medications you are currently taking:

Physician Contact info:
Seventh Client's Name

First Name*

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

PROCEDURE TYPE

COST OF PROCEDURE(s)
Please check any of the following medical conditions that apply: *
"Dry eye"
(HSV) Cold sores
ALL Hepatitis
Allergies
Alopecia
Autoimmune
Cancer(Any type)/Treatment
Cataracts
Corneal abrasions
Currently wearing contact lenses
Diabetes
Easily bruised
Excessive bleeding
Eye surgery or injury
Fever blisters/Herpes
Heart problems
High blood pressure
HIV/Aids
Keloid scars
Pregnant/Nursing
Skin Rashes(Ringworm, Psoriasis, Severe Rosacea, Eczema, Dermatitis etc)
Thyroid disease
(NONE OF THE ABOVE APPLY)

If you selected yes to any of the above, please specify in detail and fully understand you WILL be asked to request a letter of clearance from your doctor(HEALTH DEPARTMENT REQUIREMENT) before booking a procedure:

List all medications you are currently taking:

Physician Contact info:
Eighth Client's Name

First Name*

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

PROCEDURE TYPE

COST OF PROCEDURE(s)
Please check any of the following medical conditions that apply: *
"Dry eye"
(HSV) Cold sores
ALL Hepatitis
Allergies
Alopecia
Autoimmune
Cancer(Any type)/Treatment
Cataracts
Corneal abrasions
Currently wearing contact lenses
Diabetes
Easily bruised
Excessive bleeding
Eye surgery or injury
Fever blisters/Herpes
Heart problems
High blood pressure
HIV/Aids
Keloid scars
Pregnant/Nursing
Skin Rashes(Ringworm, Psoriasis, Severe Rosacea, Eczema, Dermatitis etc)
Thyroid disease
(NONE OF THE ABOVE APPLY)

If you selected yes to any of the above, please specify in detail and fully understand you WILL be asked to request a letter of clearance from your doctor(HEALTH DEPARTMENT REQUIREMENT) before booking a procedure:

List all medications you are currently taking:

Physician Contact info:
Ninth Client's Name

First Name*

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

PROCEDURE TYPE

COST OF PROCEDURE(s)
Please check any of the following medical conditions that apply: *
"Dry eye"
(HSV) Cold sores
ALL Hepatitis
Allergies
Alopecia
Autoimmune
Cancer(Any type)/Treatment
Cataracts
Corneal abrasions
Currently wearing contact lenses
Diabetes
Easily bruised
Excessive bleeding
Eye surgery or injury
Fever blisters/Herpes
Heart problems
High blood pressure
HIV/Aids
Keloid scars
Pregnant/Nursing
Skin Rashes(Ringworm, Psoriasis, Severe Rosacea, Eczema, Dermatitis etc)
Thyroid disease
(NONE OF THE ABOVE APPLY)

If you selected yes to any of the above, please specify in detail and fully understand you WILL be asked to request a letter of clearance from your doctor(HEALTH DEPARTMENT REQUIREMENT) before booking a procedure:

List all medications you are currently taking:

Physician Contact info:
Tenth Client's Name

First Name*

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

PROCEDURE TYPE

COST OF PROCEDURE(s)
Please check any of the following medical conditions that apply: *
"Dry eye"
(HSV) Cold sores
ALL Hepatitis
Allergies
Alopecia
Autoimmune
Cancer(Any type)/Treatment
Cataracts
Corneal abrasions
Currently wearing contact lenses
Diabetes
Easily bruised
Excessive bleeding
Eye surgery or injury
Fever blisters/Herpes
Heart problems
High blood pressure
HIV/Aids
Keloid scars
Pregnant/Nursing
Skin Rashes(Ringworm, Psoriasis, Severe Rosacea, Eczema, Dermatitis etc)
Thyroid disease
(NONE OF THE ABOVE APPLY)

If you selected yes to any of the above, please specify in detail and fully understand you WILL be asked to request a letter of clearance from your doctor(HEALTH DEPARTMENT REQUIREMENT) before booking a procedure:

List all medications you are currently taking:

Physician Contact info:
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*
Procedure Date

What is the date of your procedure? *
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

PROCEDURE TYPE

COST OF PROCEDURE(s)
Please check any of the following medical conditions that apply: *
"Dry eye"
(HSV) Cold sores
ALL Hepatitis
Allergies
Alopecia
Autoimmune
Cancer(Any type)/Treatment
Cataracts
Corneal abrasions
Currently wearing contact lenses
Diabetes
Easily bruised
Excessive bleeding
Eye surgery or injury
Fever blisters/Herpes
Heart problems
High blood pressure
HIV/Aids
Keloid scars
Pregnant/Nursing
Skin Rashes(Ringworm, Psoriasis, Severe Rosacea, Eczema, Dermatitis etc)
Thyroid disease
(NONE OF THE ABOVE APPLY)

If you selected yes to any of the above, please specify in detail and fully understand you WILL be asked to request a letter of clearance from your doctor(HEALTH DEPARTMENT REQUIREMENT) before booking a procedure:

List all medications you are currently taking:

Physician Contact info:
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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