Loading...

BeYou - Waiver

I am over the age of 18 and desire Sarah Giannola Owner of Beyou Microblading LLC, to perform the elective cosmetic pigmentation procedure understanding that this procedure is for cosmetic purpose only and not for health reason. If any unforeseen conditions arise during this procedure calling for his/her judgment for procedures in addition to, or, different from those now contemplated, I further request and authorize him/her to do whatever necessary in the circumstances. I am aware that no guarantees have been made to me concerning the results of the procedure(s).


July 19, 2024

I also understand that the permanent skin pigmentation procedure carries with it the possible complication 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 and Acids treatments may also compromise the semi permanent cosmetic make-up application (you should stop them 15 days before any procedure). I fully understand as with all such procedures that this is not a science but rather an art and that anything can go wrong. I request the permanent skin pigmentation procedure, appreciating and accepting the permanency of the procedure as well as the possible complications and consequences of the said procedure(s). 


July 19, 2024

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 purpose deemed necessary including using pictures for social media and advertising publications. Understanding the permanent skin pigmentation procedure, the procedure, the permanency of the procedure, and that the procedure is for cosmetic purposes only, I hereby authorize Sarah Giannola Owner of Beyou Microblading LLC, to perform the semi permanent skin pigmentation procedure(s). 


July 19, 2024

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 were filled in before I signed this statement. 


July 19, 2024

Microblading/Nanoblading procedures normally require multiple treatment sessions. For best results clients will be required to return for at least one re-touch appointment. This will take place 4 -6 weeks after the initial procedure. Those with oily skin may require an additional touch up. Please be aware that color intensity will be significantly darker and sharper immediately and a few days after the initial procedure, but the color will reduce by up to 40%. 


July 19, 2024

 

Client Treatment Consent and Release

I acknowledge that beauty treatments, the practice of skin care, and the practice of massage, including, but not limited to, microablation, microdermabrasion, waxing, electrolysis, facial toning, permanent cosmetics, body treatments, ionization, laser treatments, tattoo removal, vein treatments, brown spot removal, BOTOX, Collagen, Dermal Fillers, PRP Injections, Sclerotherapy, Mesotherapy, Dermaplaning, and various other beauty procedures is not an exact science and no specific guaranties can or have been made concerning the outcome. I understand that some clients experience more change and improvement than others. In virtually all cases, multiple treatments are required in order to realize a difference. 


July 19, 2024

I also understand and agree to assume the following risks and hazards which may occur in connection with any particular treatment including but not limited to: unsatisfactory results, soreness, poor healing, discomfort, redness, blistering, nerve damage, scarring, infection, change in skin pigmentation, allergic reaction, muscle damage, and increased hair growth. I understand that even though precautions may be taken in my treatment, not all risks can be known in advance. 


July 19, 2024

Given the above, I understand that response to treatment varies on an individual basis and that specific results are not guaranteed. Therefore, in consideration for any treatment received, I agree to unconditionally defend, hold harmless and release from any and all liability the company Beyou Microblading LLC, and the individual that provided my treatment, the insured, and any additional insureds, as well as any officers, directors, or employees of the above companie for any condition or result, known or unknown, that may arise as a consequence of any treatment that I receive. 


July 19, 2024

I have fully disclosed on my client intake form any medications, previous complications, or current conditions that may effect my treatment. I understand and agree that any legal action of any kind related to any treatment I receive will be limited to binding arbitration using a single arbitrator agreed to by both parties. 



July 19, 2024

I agree to binding arbitration or mediation in the event I wish to file a lawsuit against Sarah Giannola, Owner of Beyou Microblading LLC for any legal issues I have with my procedures.



Date: July 19, 2024

 

 

 



First Client's Name

First Name*

Last Name*

Phone*
First Client's Date of Birth*
First Client's Information
Are you allergic to penicillin or any other drug?*
No
Yes
Do you have any allergies to latex?*
No
Yes
Do you take Zovirax, valtrx or Famvir?*
No
Yes
Do you have any kind of heart trouble?*
No
Yes
Are you allergic to or ever had any reaction to Polysporin, Bactacin, Neosporin, A&D, Vaseline or topical healing ointments or products?*
No
Yes
Are you allergic to novocaine or any caine anesthesia?*
No
Yes
Are you prone to. Or have any keloid scars?*
No
Yes
Do you were contact lenses?*
No
Yes
Are you taking recreational drugs?*
No
Yes
Have you had botox in the last 3 weeks?*
No
Yes
Do you have excessively oily/dry skin?*
No
Yes, DRY
Yes, OILY
Do you have any skin conditions such as eczema?*
No
Yes
Do you agree to the fees discussed?*
No
Yes
There is a possibility of an allergic retain of pigments. A path test if advisable however it does not ensure a client will not have an allergic reaction. Patch test: (You MUST make a separate appointment if you would like a patch test and wait 3 weeks for results)*

If waived, I release the technician and assistants from liability if I develop an allergic reaction to the pigment. (Pigments contents are: iron oxide, lakes, alcohol, Glycerin and distilled. Sterile water) I acknowledge that NO GUARANTEES have been made to me concerning the results of this procedure. For the purpose of documentation, I also consent to the technician, salon or clinic. Laser treatments or ANY kind of facial injections may also compromise your permanent cosmetic makeup application.

I have read the above and had explained to me and fully understand this consent and procedure form: that the explanations therein referred to, were made, and I accept full responsibility for these or any other complications which may arise from results during or following that cosmetic procedure which is to be performed at my request according to this consent and procedure form. I also understand that this procedure is permanent.

I will follow all After Care instructions explicitly. Failing to do so will compromise my final results. 





I fully understand that a deposit of a $100 is required to schedule an appointment and is non-refundable. 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 $150 charge depending upon the amount of work needed. 




Please select all that apply : I request semi-permanent cosmetic make-up procedures *
BeYou Brow's Shaping
BrowsUp Lamination
GrowUp Brows (hair grow treatment)
Hydra Color Lips (hydration+temporary color)
Lash Lifting Tint
NanoLip Blushing
Nanoblading Eyebrows
Nanoshading Eyebrows (nanoblading + shading)

Medical consent and Procedure Chart 

If you are now taking or recently have taken any of these drugs, please select below. You may need a physician's release prior to your procedure.
Accutane
Anti- anxiety drugs
Antibiotics
Anticoagulants
Arthritis preparations
Aspirin
Blood pressure meds
Blood thinners
Diabetic meds
Heart meds
Hormones
Insulin injections
Meds for depression
Meds for mood change
Pain or headache meds
Seizure meds
Steroid preparations
tranquilizers
Please select if you have or had recently any of the following. You may need a physician's release prior to your procedure:
Accutane
Allergies to make-up
Alopecia
Anemia
Arthritis
Asthma
Autoimmune disorders
Blister on lips
Cancer (any type)
Chemical peels
Chest pains
Collagen injections
Cortisone
Diabetes
Dry eyes
Epilepsy/seizures
Excessive bleeding
Glaucoma
Gortex
Heart Conditions
Hepatitis/HIV
Herpes
Hyper-pigmentation
Hypertension
Jaundice
Keloid or hypertrophy scars
Kidney disease
Pacemaker
Refractive eye surgery
Shortness of breath
Sinus infections
Stroke
Tendency to develop fever
Trichotillomania
Could you possibly be pregnant?*
No
Yes
Are you nursing mother?*
No
Yes
Do you have any allergies to any medication?*
No
Yes
Novocain, Lidocaine or any topical anesthetics?*
No
Yes
Will you be on your menstrual cycle during the procedure?*
No
Yes
Do you smoke?*
No
Yes
What position do you sleep?
Facing down
Facing up
Left side
Right side
Have you ever had any permanent cosmetics applied on your Brows or Lips?*
No
Yes, Brows
Yes, Lips
Was pigment disposed of after your procedure was complete?*
Yes
Did you sign any Consent and Release forms?*
Yes

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 procedures(s) which is to be performed at my request according to this consent were filled in before I signed this statement. 

First Client's Signature*
Second Client's Name

First Name*

Last Name*
Second Client's Date of Birth*
Second Client's Information
Are you allergic to penicillin or any other drug?*
No
Yes
Do you have any allergies to latex?*
No
Yes
Do you take Zovirax, valtrx or Famvir?*
No
Yes
Do you have any kind of heart trouble?*
No
Yes
Are you allergic to or ever had any reaction to Polysporin, Bactacin, Neosporin, A&D, Vaseline or topical healing ointments or products?*
No
Yes
Are you allergic to novocaine or any caine anesthesia?*
No
Yes
Are you prone to. Or have any keloid scars?*
No
Yes
Do you were contact lenses?*
No
Yes
Are you taking recreational drugs?*
No
Yes
Have you had botox in the last 3 weeks?*
No
Yes
Do you have excessively oily/dry skin?*
No
Yes, DRY
Yes, OILY
Do you have any skin conditions such as eczema?*
No
Yes
Do you agree to the fees discussed?*
No
Yes
There is a possibility of an allergic retain of pigments. A path test if advisable however it does not ensure a client will not have an allergic reaction. Patch test: (You MUST make a separate appointment if you would like a patch test and wait 3 weeks for results)*

If waived, I release the technician and assistants from liability if I develop an allergic reaction to the pigment. (Pigments contents are: iron oxide, lakes, alcohol, Glycerin and distilled. Sterile water) I acknowledge that NO GUARANTEES have been made to me concerning the results of this procedure. For the purpose of documentation, I also consent to the technician, salon or clinic. Laser treatments or ANY kind of facial injections may also compromise your permanent cosmetic makeup application.

I have read the above and had explained to me and fully understand this consent and procedure form: that the explanations therein referred to, were made, and I accept full responsibility for these or any other complications which may arise from results during or following that cosmetic procedure which is to be performed at my request according to this consent and procedure form. I also understand that this procedure is permanent.

I will follow all After Care instructions explicitly. Failing to do so will compromise my final results. 





I fully understand that a deposit of a $100 is required to schedule an appointment and is non-refundable. 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 $150 charge depending upon the amount of work needed. 




Please select all that apply : I request semi-permanent cosmetic make-up procedures *
BeYou Brow's Shaping
BrowsUp Lamination
GrowUp Brows (hair grow treatment)
Hydra Color Lips (hydration+temporary color)
Lash Lifting Tint
NanoLip Blushing
Nanoblading Eyebrows
Nanoshading Eyebrows (nanoblading + shading)

Medical consent and Procedure Chart 

If you are now taking or recently have taken any of these drugs, please select below. You may need a physician's release prior to your procedure.
Accutane
Anti- anxiety drugs
Antibiotics
Anticoagulants
Arthritis preparations
Aspirin
Blood pressure meds
Blood thinners
Diabetic meds
Heart meds
Hormones
Insulin injections
Meds for depression
Meds for mood change
Pain or headache meds
Seizure meds
Steroid preparations
tranquilizers
Please select if you have or had recently any of the following. You may need a physician's release prior to your procedure:
Accutane
Allergies to make-up
Alopecia
Anemia
Arthritis
Asthma
Autoimmune disorders
Blister on lips
Cancer (any type)
Chemical peels
Chest pains
Collagen injections
Cortisone
Diabetes
Dry eyes
Epilepsy/seizures
Excessive bleeding
Glaucoma
Gortex
Heart Conditions
Hepatitis/HIV
Herpes
Hyper-pigmentation
Hypertension
Jaundice
Keloid or hypertrophy scars
Kidney disease
Pacemaker
Refractive eye surgery
Shortness of breath
Sinus infections
Stroke
Tendency to develop fever
Trichotillomania
Could you possibly be pregnant?*
No
Yes
Are you nursing mother?*
No
Yes
Do you have any allergies to any medication?*
No
Yes
Novocain, Lidocaine or any topical anesthetics?*
No
Yes
Will you be on your menstrual cycle during the procedure?*
No
Yes
Do you smoke?*
No
Yes
What position do you sleep?
Facing down
Facing up
Left side
Right side
Have you ever had any permanent cosmetics applied on your Brows or Lips?*
No
Yes, Brows
Yes, Lips
Was pigment disposed of after your procedure was complete?*
Yes
Did you sign any Consent and Release forms?*
Yes

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 procedures(s) which is to be performed at my request according to this consent were filled in before I signed this statement. 

Third Client's Name

First Name*

Last Name*
Third Client's Date of Birth*
Third Client's Information
Are you allergic to penicillin or any other drug?*
No
Yes
Do you have any allergies to latex?*
No
Yes
Do you take Zovirax, valtrx or Famvir?*
No
Yes
Do you have any kind of heart trouble?*
No
Yes
Are you allergic to or ever had any reaction to Polysporin, Bactacin, Neosporin, A&D, Vaseline or topical healing ointments or products?*
No
Yes
Are you allergic to novocaine or any caine anesthesia?*
No
Yes
Are you prone to. Or have any keloid scars?*
No
Yes
Do you were contact lenses?*
No
Yes
Are you taking recreational drugs?*
No
Yes
Have you had botox in the last 3 weeks?*
No
Yes
Do you have excessively oily/dry skin?*
No
Yes, DRY
Yes, OILY
Do you have any skin conditions such as eczema?*
No
Yes
Do you agree to the fees discussed?*
No
Yes
There is a possibility of an allergic retain of pigments. A path test if advisable however it does not ensure a client will not have an allergic reaction. Patch test: (You MUST make a separate appointment if you would like a patch test and wait 3 weeks for results)*

If waived, I release the technician and assistants from liability if I develop an allergic reaction to the pigment. (Pigments contents are: iron oxide, lakes, alcohol, Glycerin and distilled. Sterile water) I acknowledge that NO GUARANTEES have been made to me concerning the results of this procedure. For the purpose of documentation, I also consent to the technician, salon or clinic. Laser treatments or ANY kind of facial injections may also compromise your permanent cosmetic makeup application.

I have read the above and had explained to me and fully understand this consent and procedure form: that the explanations therein referred to, were made, and I accept full responsibility for these or any other complications which may arise from results during or following that cosmetic procedure which is to be performed at my request according to this consent and procedure form. I also understand that this procedure is permanent.

I will follow all After Care instructions explicitly. Failing to do so will compromise my final results. 





I fully understand that a deposit of a $100 is required to schedule an appointment and is non-refundable. 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 $150 charge depending upon the amount of work needed. 




Please select all that apply : I request semi-permanent cosmetic make-up procedures *
BeYou Brow's Shaping
BrowsUp Lamination
GrowUp Brows (hair grow treatment)
Hydra Color Lips (hydration+temporary color)
Lash Lifting Tint
NanoLip Blushing
Nanoblading Eyebrows
Nanoshading Eyebrows (nanoblading + shading)

Medical consent and Procedure Chart 

If you are now taking or recently have taken any of these drugs, please select below. You may need a physician's release prior to your procedure.
Accutane
Anti- anxiety drugs
Antibiotics
Anticoagulants
Arthritis preparations
Aspirin
Blood pressure meds
Blood thinners
Diabetic meds
Heart meds
Hormones
Insulin injections
Meds for depression
Meds for mood change
Pain or headache meds
Seizure meds
Steroid preparations
tranquilizers
Please select if you have or had recently any of the following. You may need a physician's release prior to your procedure:
Accutane
Allergies to make-up
Alopecia
Anemia
Arthritis
Asthma
Autoimmune disorders
Blister on lips
Cancer (any type)
Chemical peels
Chest pains
Collagen injections
Cortisone
Diabetes
Dry eyes
Epilepsy/seizures
Excessive bleeding
Glaucoma
Gortex
Heart Conditions
Hepatitis/HIV
Herpes
Hyper-pigmentation
Hypertension
Jaundice
Keloid or hypertrophy scars
Kidney disease
Pacemaker
Refractive eye surgery
Shortness of breath
Sinus infections
Stroke
Tendency to develop fever
Trichotillomania
Could you possibly be pregnant?*
No
Yes
Are you nursing mother?*
No
Yes
Do you have any allergies to any medication?*
No
Yes
Novocain, Lidocaine or any topical anesthetics?*
No
Yes
Will you be on your menstrual cycle during the procedure?*
No
Yes
Do you smoke?*
No
Yes
What position do you sleep?
Facing down
Facing up
Left side
Right side
Have you ever had any permanent cosmetics applied on your Brows or Lips?*
No
Yes, Brows
Yes, Lips
Was pigment disposed of after your procedure was complete?*
Yes
Did you sign any Consent and Release forms?*
Yes

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 procedures(s) which is to be performed at my request according to this consent were filled in before I signed this statement. 

Fourth Client's Name

First Name*

Last Name*
Fourth Client's Date of Birth*
Fourth Client's Information
Are you allergic to penicillin or any other drug?*
No
Yes
Do you have any allergies to latex?*
No
Yes
Do you take Zovirax, valtrx or Famvir?*
No
Yes
Do you have any kind of heart trouble?*
No
Yes
Are you allergic to or ever had any reaction to Polysporin, Bactacin, Neosporin, A&D, Vaseline or topical healing ointments or products?*
No
Yes
Are you allergic to novocaine or any caine anesthesia?*
No
Yes
Are you prone to. Or have any keloid scars?*
No
Yes
Do you were contact lenses?*
No
Yes
Are you taking recreational drugs?*
No
Yes
Have you had botox in the last 3 weeks?*
No
Yes
Do you have excessively oily/dry skin?*
No
Yes, DRY
Yes, OILY
Do you have any skin conditions such as eczema?*
No
Yes
Do you agree to the fees discussed?*
No
Yes
There is a possibility of an allergic retain of pigments. A path test if advisable however it does not ensure a client will not have an allergic reaction. Patch test: (You MUST make a separate appointment if you would like a patch test and wait 3 weeks for results)*

If waived, I release the technician and assistants from liability if I develop an allergic reaction to the pigment. (Pigments contents are: iron oxide, lakes, alcohol, Glycerin and distilled. Sterile water) I acknowledge that NO GUARANTEES have been made to me concerning the results of this procedure. For the purpose of documentation, I also consent to the technician, salon or clinic. Laser treatments or ANY kind of facial injections may also compromise your permanent cosmetic makeup application.

I have read the above and had explained to me and fully understand this consent and procedure form: that the explanations therein referred to, were made, and I accept full responsibility for these or any other complications which may arise from results during or following that cosmetic procedure which is to be performed at my request according to this consent and procedure form. I also understand that this procedure is permanent.

I will follow all After Care instructions explicitly. Failing to do so will compromise my final results. 





I fully understand that a deposit of a $100 is required to schedule an appointment and is non-refundable. 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 $150 charge depending upon the amount of work needed. 




Please select all that apply : I request semi-permanent cosmetic make-up procedures *
BeYou Brow's Shaping
BrowsUp Lamination
GrowUp Brows (hair grow treatment)
Hydra Color Lips (hydration+temporary color)
Lash Lifting Tint
NanoLip Blushing
Nanoblading Eyebrows
Nanoshading Eyebrows (nanoblading + shading)

Medical consent and Procedure Chart 

If you are now taking or recently have taken any of these drugs, please select below. You may need a physician's release prior to your procedure.
Accutane
Anti- anxiety drugs
Antibiotics
Anticoagulants
Arthritis preparations
Aspirin
Blood pressure meds
Blood thinners
Diabetic meds
Heart meds
Hormones
Insulin injections
Meds for depression
Meds for mood change
Pain or headache meds
Seizure meds
Steroid preparations
tranquilizers
Please select if you have or had recently any of the following. You may need a physician's release prior to your procedure:
Accutane
Allergies to make-up
Alopecia
Anemia
Arthritis
Asthma
Autoimmune disorders
Blister on lips
Cancer (any type)
Chemical peels
Chest pains
Collagen injections
Cortisone
Diabetes
Dry eyes
Epilepsy/seizures
Excessive bleeding
Glaucoma
Gortex
Heart Conditions
Hepatitis/HIV
Herpes
Hyper-pigmentation
Hypertension
Jaundice
Keloid or hypertrophy scars
Kidney disease
Pacemaker
Refractive eye surgery
Shortness of breath
Sinus infections
Stroke
Tendency to develop fever
Trichotillomania
Could you possibly be pregnant?*
No
Yes
Are you nursing mother?*
No
Yes
Do you have any allergies to any medication?*
No
Yes
Novocain, Lidocaine or any topical anesthetics?*
No
Yes
Will you be on your menstrual cycle during the procedure?*
No
Yes
Do you smoke?*
No
Yes
What position do you sleep?
Facing down
Facing up
Left side
Right side
Have you ever had any permanent cosmetics applied on your Brows or Lips?*
No
Yes, Brows
Yes, Lips
Was pigment disposed of after your procedure was complete?*
Yes
Did you sign any Consent and Release forms?*
Yes

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 procedures(s) which is to be performed at my request according to this consent were filled in before I signed this statement. 

Fifth Client's Name

First Name*

Last Name*
Fifth Client's Date of Birth*
Fifth Client's Information
Are you allergic to penicillin or any other drug?*
No
Yes
Do you have any allergies to latex?*
No
Yes
Do you take Zovirax, valtrx or Famvir?*
No
Yes
Do you have any kind of heart trouble?*
No
Yes
Are you allergic to or ever had any reaction to Polysporin, Bactacin, Neosporin, A&D, Vaseline or topical healing ointments or products?*
No
Yes
Are you allergic to novocaine or any caine anesthesia?*
No
Yes
Are you prone to. Or have any keloid scars?*
No
Yes
Do you were contact lenses?*
No
Yes
Are you taking recreational drugs?*
No
Yes
Have you had botox in the last 3 weeks?*
No
Yes
Do you have excessively oily/dry skin?*
No
Yes, DRY
Yes, OILY
Do you have any skin conditions such as eczema?*
No
Yes
Do you agree to the fees discussed?*
No
Yes
There is a possibility of an allergic retain of pigments. A path test if advisable however it does not ensure a client will not have an allergic reaction. Patch test: (You MUST make a separate appointment if you would like a patch test and wait 3 weeks for results)*

If waived, I release the technician and assistants from liability if I develop an allergic reaction to the pigment. (Pigments contents are: iron oxide, lakes, alcohol, Glycerin and distilled. Sterile water) I acknowledge that NO GUARANTEES have been made to me concerning the results of this procedure. For the purpose of documentation, I also consent to the technician, salon or clinic. Laser treatments or ANY kind of facial injections may also compromise your permanent cosmetic makeup application.

I have read the above and had explained to me and fully understand this consent and procedure form: that the explanations therein referred to, were made, and I accept full responsibility for these or any other complications which may arise from results during or following that cosmetic procedure which is to be performed at my request according to this consent and procedure form. I also understand that this procedure is permanent.

I will follow all After Care instructions explicitly. Failing to do so will compromise my final results. 





I fully understand that a deposit of a $100 is required to schedule an appointment and is non-refundable. 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 $150 charge depending upon the amount of work needed. 




Please select all that apply : I request semi-permanent cosmetic make-up procedures *
BeYou Brow's Shaping
BrowsUp Lamination
GrowUp Brows (hair grow treatment)
Hydra Color Lips (hydration+temporary color)
Lash Lifting Tint
NanoLip Blushing
Nanoblading Eyebrows
Nanoshading Eyebrows (nanoblading + shading)

Medical consent and Procedure Chart 

If you are now taking or recently have taken any of these drugs, please select below. You may need a physician's release prior to your procedure.
Accutane
Anti- anxiety drugs
Antibiotics
Anticoagulants
Arthritis preparations
Aspirin
Blood pressure meds
Blood thinners
Diabetic meds
Heart meds
Hormones
Insulin injections
Meds for depression
Meds for mood change
Pain or headache meds
Seizure meds
Steroid preparations
tranquilizers
Please select if you have or had recently any of the following. You may need a physician's release prior to your procedure:
Accutane
Allergies to make-up
Alopecia
Anemia
Arthritis
Asthma
Autoimmune disorders
Blister on lips
Cancer (any type)
Chemical peels
Chest pains
Collagen injections
Cortisone
Diabetes
Dry eyes
Epilepsy/seizures
Excessive bleeding
Glaucoma
Gortex
Heart Conditions
Hepatitis/HIV
Herpes
Hyper-pigmentation
Hypertension
Jaundice
Keloid or hypertrophy scars
Kidney disease
Pacemaker
Refractive eye surgery
Shortness of breath
Sinus infections
Stroke
Tendency to develop fever
Trichotillomania
Could you possibly be pregnant?*
No
Yes
Are you nursing mother?*
No
Yes
Do you have any allergies to any medication?*
No
Yes
Novocain, Lidocaine or any topical anesthetics?*
No
Yes
Will you be on your menstrual cycle during the procedure?*
No
Yes
Do you smoke?*
No
Yes
What position do you sleep?
Facing down
Facing up
Left side
Right side
Have you ever had any permanent cosmetics applied on your Brows or Lips?*
No
Yes, Brows
Yes, Lips
Was pigment disposed of after your procedure was complete?*
Yes
Did you sign any Consent and Release forms?*
Yes

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 procedures(s) which is to be performed at my request according to this consent were filled in before I signed this statement. 

Sixth Client's Name

First Name*

Last Name*
Sixth Client's Date of Birth*
Sixth Client's Information
Are you allergic to penicillin or any other drug?*
No
Yes
Do you have any allergies to latex?*
No
Yes
Do you take Zovirax, valtrx or Famvir?*
No
Yes
Do you have any kind of heart trouble?*
No
Yes
Are you allergic to or ever had any reaction to Polysporin, Bactacin, Neosporin, A&D, Vaseline or topical healing ointments or products?*
No
Yes
Are you allergic to novocaine or any caine anesthesia?*
No
Yes
Are you prone to. Or have any keloid scars?*
No
Yes
Do you were contact lenses?*
No
Yes
Are you taking recreational drugs?*
No
Yes
Have you had botox in the last 3 weeks?*
No
Yes
Do you have excessively oily/dry skin?*
No
Yes, DRY
Yes, OILY
Do you have any skin conditions such as eczema?*
No
Yes
Do you agree to the fees discussed?*
No
Yes
There is a possibility of an allergic retain of pigments. A path test if advisable however it does not ensure a client will not have an allergic reaction. Patch test: (You MUST make a separate appointment if you would like a patch test and wait 3 weeks for results)*

If waived, I release the technician and assistants from liability if I develop an allergic reaction to the pigment. (Pigments contents are: iron oxide, lakes, alcohol, Glycerin and distilled. Sterile water) I acknowledge that NO GUARANTEES have been made to me concerning the results of this procedure. For the purpose of documentation, I also consent to the technician, salon or clinic. Laser treatments or ANY kind of facial injections may also compromise your permanent cosmetic makeup application.

I have read the above and had explained to me and fully understand this consent and procedure form: that the explanations therein referred to, were made, and I accept full responsibility for these or any other complications which may arise from results during or following that cosmetic procedure which is to be performed at my request according to this consent and procedure form. I also understand that this procedure is permanent.

I will follow all After Care instructions explicitly. Failing to do so will compromise my final results. 





I fully understand that a deposit of a $100 is required to schedule an appointment and is non-refundable. 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 $150 charge depending upon the amount of work needed. 




Please select all that apply : I request semi-permanent cosmetic make-up procedures *
BeYou Brow's Shaping
BrowsUp Lamination
GrowUp Brows (hair grow treatment)
Hydra Color Lips (hydration+temporary color)
Lash Lifting Tint
NanoLip Blushing
Nanoblading Eyebrows
Nanoshading Eyebrows (nanoblading + shading)

Medical consent and Procedure Chart 

If you are now taking or recently have taken any of these drugs, please select below. You may need a physician's release prior to your procedure.
Accutane
Anti- anxiety drugs
Antibiotics
Anticoagulants
Arthritis preparations
Aspirin
Blood pressure meds
Blood thinners
Diabetic meds
Heart meds
Hormones
Insulin injections
Meds for depression
Meds for mood change
Pain or headache meds
Seizure meds
Steroid preparations
tranquilizers
Please select if you have or had recently any of the following. You may need a physician's release prior to your procedure:
Accutane
Allergies to make-up
Alopecia
Anemia
Arthritis
Asthma
Autoimmune disorders
Blister on lips
Cancer (any type)
Chemical peels
Chest pains
Collagen injections
Cortisone
Diabetes
Dry eyes
Epilepsy/seizures
Excessive bleeding
Glaucoma
Gortex
Heart Conditions
Hepatitis/HIV
Herpes
Hyper-pigmentation
Hypertension
Jaundice
Keloid or hypertrophy scars
Kidney disease
Pacemaker
Refractive eye surgery
Shortness of breath
Sinus infections
Stroke
Tendency to develop fever
Trichotillomania
Could you possibly be pregnant?*
No
Yes
Are you nursing mother?*
No
Yes
Do you have any allergies to any medication?*
No
Yes
Novocain, Lidocaine or any topical anesthetics?*
No
Yes
Will you be on your menstrual cycle during the procedure?*
No
Yes
Do you smoke?*
No
Yes
What position do you sleep?
Facing down
Facing up
Left side
Right side
Have you ever had any permanent cosmetics applied on your Brows or Lips?*
No
Yes, Brows
Yes, Lips
Was pigment disposed of after your procedure was complete?*
Yes
Did you sign any Consent and Release forms?*
Yes

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 procedures(s) which is to be performed at my request according to this consent were filled in before I signed this statement. 

Seventh Client's Name

First Name*

Last Name*
Seventh Client's Date of Birth*
Seventh Client's Information
Are you allergic to penicillin or any other drug?*
No
Yes
Do you have any allergies to latex?*
No
Yes
Do you take Zovirax, valtrx or Famvir?*
No
Yes
Do you have any kind of heart trouble?*
No
Yes
Are you allergic to or ever had any reaction to Polysporin, Bactacin, Neosporin, A&D, Vaseline or topical healing ointments or products?*
No
Yes
Are you allergic to novocaine or any caine anesthesia?*
No
Yes
Are you prone to. Or have any keloid scars?*
No
Yes
Do you were contact lenses?*
No
Yes
Are you taking recreational drugs?*
No
Yes
Have you had botox in the last 3 weeks?*
No
Yes
Do you have excessively oily/dry skin?*
No
Yes, DRY
Yes, OILY
Do you have any skin conditions such as eczema?*
No
Yes
Do you agree to the fees discussed?*
No
Yes
There is a possibility of an allergic retain of pigments. A path test if advisable however it does not ensure a client will not have an allergic reaction. Patch test: (You MUST make a separate appointment if you would like a patch test and wait 3 weeks for results)*

If waived, I release the technician and assistants from liability if I develop an allergic reaction to the pigment. (Pigments contents are: iron oxide, lakes, alcohol, Glycerin and distilled. Sterile water) I acknowledge that NO GUARANTEES have been made to me concerning the results of this procedure. For the purpose of documentation, I also consent to the technician, salon or clinic. Laser treatments or ANY kind of facial injections may also compromise your permanent cosmetic makeup application.

I have read the above and had explained to me and fully understand this consent and procedure form: that the explanations therein referred to, were made, and I accept full responsibility for these or any other complications which may arise from results during or following that cosmetic procedure which is to be performed at my request according to this consent and procedure form. I also understand that this procedure is permanent.

I will follow all After Care instructions explicitly. Failing to do so will compromise my final results. 





I fully understand that a deposit of a $100 is required to schedule an appointment and is non-refundable. 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 $150 charge depending upon the amount of work needed. 




Please select all that apply : I request semi-permanent cosmetic make-up procedures *
BeYou Brow's Shaping
BrowsUp Lamination
GrowUp Brows (hair grow treatment)
Hydra Color Lips (hydration+temporary color)
Lash Lifting Tint
NanoLip Blushing
Nanoblading Eyebrows
Nanoshading Eyebrows (nanoblading + shading)

Medical consent and Procedure Chart 

If you are now taking or recently have taken any of these drugs, please select below. You may need a physician's release prior to your procedure.
Accutane
Anti- anxiety drugs
Antibiotics
Anticoagulants
Arthritis preparations
Aspirin
Blood pressure meds
Blood thinners
Diabetic meds
Heart meds
Hormones
Insulin injections
Meds for depression
Meds for mood change
Pain or headache meds
Seizure meds
Steroid preparations
tranquilizers
Please select if you have or had recently any of the following. You may need a physician's release prior to your procedure:
Accutane
Allergies to make-up
Alopecia
Anemia
Arthritis
Asthma
Autoimmune disorders
Blister on lips
Cancer (any type)
Chemical peels
Chest pains
Collagen injections
Cortisone
Diabetes
Dry eyes
Epilepsy/seizures
Excessive bleeding
Glaucoma
Gortex
Heart Conditions
Hepatitis/HIV
Herpes
Hyper-pigmentation
Hypertension
Jaundice
Keloid or hypertrophy scars
Kidney disease
Pacemaker
Refractive eye surgery
Shortness of breath
Sinus infections
Stroke
Tendency to develop fever
Trichotillomania
Could you possibly be pregnant?*
No
Yes
Are you nursing mother?*
No
Yes
Do you have any allergies to any medication?*
No
Yes
Novocain, Lidocaine or any topical anesthetics?*
No
Yes
Will you be on your menstrual cycle during the procedure?*
No
Yes
Do you smoke?*
No
Yes
What position do you sleep?
Facing down
Facing up
Left side
Right side
Have you ever had any permanent cosmetics applied on your Brows or Lips?*
No
Yes, Brows
Yes, Lips
Was pigment disposed of after your procedure was complete?*
Yes
Did you sign any Consent and Release forms?*
Yes

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 procedures(s) which is to be performed at my request according to this consent were filled in before I signed this statement. 

Eighth Client's Name

First Name*

Last Name*
Eighth Client's Date of Birth*
Eighth Client's Information
Are you allergic to penicillin or any other drug?*
No
Yes
Do you have any allergies to latex?*
No
Yes
Do you take Zovirax, valtrx or Famvir?*
No
Yes
Do you have any kind of heart trouble?*
No
Yes
Are you allergic to or ever had any reaction to Polysporin, Bactacin, Neosporin, A&D, Vaseline or topical healing ointments or products?*
No
Yes
Are you allergic to novocaine or any caine anesthesia?*
No
Yes
Are you prone to. Or have any keloid scars?*
No
Yes
Do you were contact lenses?*
No
Yes
Are you taking recreational drugs?*
No
Yes
Have you had botox in the last 3 weeks?*
No
Yes
Do you have excessively oily/dry skin?*
No
Yes, DRY
Yes, OILY
Do you have any skin conditions such as eczema?*
No
Yes
Do you agree to the fees discussed?*
No
Yes
There is a possibility of an allergic retain of pigments. A path test if advisable however it does not ensure a client will not have an allergic reaction. Patch test: (You MUST make a separate appointment if you would like a patch test and wait 3 weeks for results)*

If waived, I release the technician and assistants from liability if I develop an allergic reaction to the pigment. (Pigments contents are: iron oxide, lakes, alcohol, Glycerin and distilled. Sterile water) I acknowledge that NO GUARANTEES have been made to me concerning the results of this procedure. For the purpose of documentation, I also consent to the technician, salon or clinic. Laser treatments or ANY kind of facial injections may also compromise your permanent cosmetic makeup application.

I have read the above and had explained to me and fully understand this consent and procedure form: that the explanations therein referred to, were made, and I accept full responsibility for these or any other complications which may arise from results during or following that cosmetic procedure which is to be performed at my request according to this consent and procedure form. I also understand that this procedure is permanent.

I will follow all After Care instructions explicitly. Failing to do so will compromise my final results. 





I fully understand that a deposit of a $100 is required to schedule an appointment and is non-refundable. 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 $150 charge depending upon the amount of work needed. 




Please select all that apply : I request semi-permanent cosmetic make-up procedures *
BeYou Brow's Shaping
BrowsUp Lamination
GrowUp Brows (hair grow treatment)
Hydra Color Lips (hydration+temporary color)
Lash Lifting Tint
NanoLip Blushing
Nanoblading Eyebrows
Nanoshading Eyebrows (nanoblading + shading)

Medical consent and Procedure Chart 

If you are now taking or recently have taken any of these drugs, please select below. You may need a physician's release prior to your procedure.
Accutane
Anti- anxiety drugs
Antibiotics
Anticoagulants
Arthritis preparations
Aspirin
Blood pressure meds
Blood thinners
Diabetic meds
Heart meds
Hormones
Insulin injections
Meds for depression
Meds for mood change
Pain or headache meds
Seizure meds
Steroid preparations
tranquilizers
Please select if you have or had recently any of the following. You may need a physician's release prior to your procedure:
Accutane
Allergies to make-up
Alopecia
Anemia
Arthritis
Asthma
Autoimmune disorders
Blister on lips
Cancer (any type)
Chemical peels
Chest pains
Collagen injections
Cortisone
Diabetes
Dry eyes
Epilepsy/seizures
Excessive bleeding
Glaucoma
Gortex
Heart Conditions
Hepatitis/HIV
Herpes
Hyper-pigmentation
Hypertension
Jaundice
Keloid or hypertrophy scars
Kidney disease
Pacemaker
Refractive eye surgery
Shortness of breath
Sinus infections
Stroke
Tendency to develop fever
Trichotillomania
Could you possibly be pregnant?*
No
Yes
Are you nursing mother?*
No
Yes
Do you have any allergies to any medication?*
No
Yes
Novocain, Lidocaine or any topical anesthetics?*
No
Yes
Will you be on your menstrual cycle during the procedure?*
No
Yes
Do you smoke?*
No
Yes
What position do you sleep?
Facing down
Facing up
Left side
Right side
Have you ever had any permanent cosmetics applied on your Brows or Lips?*
No
Yes, Brows
Yes, Lips
Was pigment disposed of after your procedure was complete?*
Yes
Did you sign any Consent and Release forms?*
Yes

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 procedures(s) which is to be performed at my request according to this consent were filled in before I signed this statement. 

Ninth Client's Name

First Name*

Last Name*
Ninth Client's Date of Birth*
Ninth Client's Information
Are you allergic to penicillin or any other drug?*
No
Yes
Do you have any allergies to latex?*
No
Yes
Do you take Zovirax, valtrx or Famvir?*
No
Yes
Do you have any kind of heart trouble?*
No
Yes
Are you allergic to or ever had any reaction to Polysporin, Bactacin, Neosporin, A&D, Vaseline or topical healing ointments or products?*
No
Yes
Are you allergic to novocaine or any caine anesthesia?*
No
Yes
Are you prone to. Or have any keloid scars?*
No
Yes
Do you were contact lenses?*
No
Yes
Are you taking recreational drugs?*
No
Yes
Have you had botox in the last 3 weeks?*
No
Yes
Do you have excessively oily/dry skin?*
No
Yes, DRY
Yes, OILY
Do you have any skin conditions such as eczema?*
No
Yes
Do you agree to the fees discussed?*
No
Yes
There is a possibility of an allergic retain of pigments. A path test if advisable however it does not ensure a client will not have an allergic reaction. Patch test: (You MUST make a separate appointment if you would like a patch test and wait 3 weeks for results)*

If waived, I release the technician and assistants from liability if I develop an allergic reaction to the pigment. (Pigments contents are: iron oxide, lakes, alcohol, Glycerin and distilled. Sterile water) I acknowledge that NO GUARANTEES have been made to me concerning the results of this procedure. For the purpose of documentation, I also consent to the technician, salon or clinic. Laser treatments or ANY kind of facial injections may also compromise your permanent cosmetic makeup application.

I have read the above and had explained to me and fully understand this consent and procedure form: that the explanations therein referred to, were made, and I accept full responsibility for these or any other complications which may arise from results during or following that cosmetic procedure which is to be performed at my request according to this consent and procedure form. I also understand that this procedure is permanent.

I will follow all After Care instructions explicitly. Failing to do so will compromise my final results. 





I fully understand that a deposit of a $100 is required to schedule an appointment and is non-refundable. 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 $150 charge depending upon the amount of work needed. 




Please select all that apply : I request semi-permanent cosmetic make-up procedures *
BeYou Brow's Shaping
BrowsUp Lamination
GrowUp Brows (hair grow treatment)
Hydra Color Lips (hydration+temporary color)
Lash Lifting Tint
NanoLip Blushing
Nanoblading Eyebrows
Nanoshading Eyebrows (nanoblading + shading)

Medical consent and Procedure Chart 

If you are now taking or recently have taken any of these drugs, please select below. You may need a physician's release prior to your procedure.
Accutane
Anti- anxiety drugs
Antibiotics
Anticoagulants
Arthritis preparations
Aspirin
Blood pressure meds
Blood thinners
Diabetic meds
Heart meds
Hormones
Insulin injections
Meds for depression
Meds for mood change
Pain or headache meds
Seizure meds
Steroid preparations
tranquilizers
Please select if you have or had recently any of the following. You may need a physician's release prior to your procedure:
Accutane
Allergies to make-up
Alopecia
Anemia
Arthritis
Asthma
Autoimmune disorders
Blister on lips
Cancer (any type)
Chemical peels
Chest pains
Collagen injections
Cortisone
Diabetes
Dry eyes
Epilepsy/seizures
Excessive bleeding
Glaucoma
Gortex
Heart Conditions
Hepatitis/HIV
Herpes
Hyper-pigmentation
Hypertension
Jaundice
Keloid or hypertrophy scars
Kidney disease
Pacemaker
Refractive eye surgery
Shortness of breath
Sinus infections
Stroke
Tendency to develop fever
Trichotillomania
Could you possibly be pregnant?*
No
Yes
Are you nursing mother?*
No
Yes
Do you have any allergies to any medication?*
No
Yes
Novocain, Lidocaine or any topical anesthetics?*
No
Yes
Will you be on your menstrual cycle during the procedure?*
No
Yes
Do you smoke?*
No
Yes
What position do you sleep?
Facing down
Facing up
Left side
Right side
Have you ever had any permanent cosmetics applied on your Brows or Lips?*
No
Yes, Brows
Yes, Lips
Was pigment disposed of after your procedure was complete?*
Yes
Did you sign any Consent and Release forms?*
Yes

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 procedures(s) which is to be performed at my request according to this consent were filled in before I signed this statement. 

Tenth Client's Name

First Name*

Last Name*
Tenth Client's Date of Birth*
Tenth Client's Information
Are you allergic to penicillin or any other drug?*
No
Yes
Do you have any allergies to latex?*
No
Yes
Do you take Zovirax, valtrx or Famvir?*
No
Yes
Do you have any kind of heart trouble?*
No
Yes
Are you allergic to or ever had any reaction to Polysporin, Bactacin, Neosporin, A&D, Vaseline or topical healing ointments or products?*
No
Yes
Are you allergic to novocaine or any caine anesthesia?*
No
Yes
Are you prone to. Or have any keloid scars?*
No
Yes
Do you were contact lenses?*
No
Yes
Are you taking recreational drugs?*
No
Yes
Have you had botox in the last 3 weeks?*
No
Yes
Do you have excessively oily/dry skin?*
No
Yes, DRY
Yes, OILY
Do you have any skin conditions such as eczema?*
No
Yes
Do you agree to the fees discussed?*
No
Yes
There is a possibility of an allergic retain of pigments. A path test if advisable however it does not ensure a client will not have an allergic reaction. Patch test: (You MUST make a separate appointment if you would like a patch test and wait 3 weeks for results)*

If waived, I release the technician and assistants from liability if I develop an allergic reaction to the pigment. (Pigments contents are: iron oxide, lakes, alcohol, Glycerin and distilled. Sterile water) I acknowledge that NO GUARANTEES have been made to me concerning the results of this procedure. For the purpose of documentation, I also consent to the technician, salon or clinic. Laser treatments or ANY kind of facial injections may also compromise your permanent cosmetic makeup application.

I have read the above and had explained to me and fully understand this consent and procedure form: that the explanations therein referred to, were made, and I accept full responsibility for these or any other complications which may arise from results during or following that cosmetic procedure which is to be performed at my request according to this consent and procedure form. I also understand that this procedure is permanent.

I will follow all After Care instructions explicitly. Failing to do so will compromise my final results. 





I fully understand that a deposit of a $100 is required to schedule an appointment and is non-refundable. 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 $150 charge depending upon the amount of work needed. 




Please select all that apply : I request semi-permanent cosmetic make-up procedures *
BeYou Brow's Shaping
BrowsUp Lamination
GrowUp Brows (hair grow treatment)
Hydra Color Lips (hydration+temporary color)
Lash Lifting Tint
NanoLip Blushing
Nanoblading Eyebrows
Nanoshading Eyebrows (nanoblading + shading)

Medical consent and Procedure Chart 

If you are now taking or recently have taken any of these drugs, please select below. You may need a physician's release prior to your procedure.
Accutane
Anti- anxiety drugs
Antibiotics
Anticoagulants
Arthritis preparations
Aspirin
Blood pressure meds
Blood thinners
Diabetic meds
Heart meds
Hormones
Insulin injections
Meds for depression
Meds for mood change
Pain or headache meds
Seizure meds
Steroid preparations
tranquilizers
Please select if you have or had recently any of the following. You may need a physician's release prior to your procedure:
Accutane
Allergies to make-up
Alopecia
Anemia
Arthritis
Asthma
Autoimmune disorders
Blister on lips
Cancer (any type)
Chemical peels
Chest pains
Collagen injections
Cortisone
Diabetes
Dry eyes
Epilepsy/seizures
Excessive bleeding
Glaucoma
Gortex
Heart Conditions
Hepatitis/HIV
Herpes
Hyper-pigmentation
Hypertension
Jaundice
Keloid or hypertrophy scars
Kidney disease
Pacemaker
Refractive eye surgery
Shortness of breath
Sinus infections
Stroke
Tendency to develop fever
Trichotillomania
Could you possibly be pregnant?*
No
Yes
Are you nursing mother?*
No
Yes
Do you have any allergies to any medication?*
No
Yes
Novocain, Lidocaine or any topical anesthetics?*
No
Yes
Will you be on your menstrual cycle during the procedure?*
No
Yes
Do you smoke?*
No
Yes
What position do you sleep?
Facing down
Facing up
Left side
Right side
Have you ever had any permanent cosmetics applied on your Brows or Lips?*
No
Yes, Brows
Yes, Lips
Was pigment disposed of after your procedure was complete?*
Yes
Did you sign any Consent and Release forms?*
Yes

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 procedures(s) which is to be performed at my request according to this consent were filled in before I signed this statement. 

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
Are you allergic to penicillin or any other drug?*
No
Yes
Do you have any allergies to latex?*
No
Yes
Do you take Zovirax, valtrx or Famvir?*
No
Yes
Do you have any kind of heart trouble?*
No
Yes
Are you allergic to or ever had any reaction to Polysporin, Bactacin, Neosporin, A&D, Vaseline or topical healing ointments or products?*
No
Yes
Are you allergic to novocaine or any caine anesthesia?*
No
Yes
Are you prone to. Or have any keloid scars?*
No
Yes
Do you were contact lenses?*
No
Yes
Are you taking recreational drugs?*
No
Yes
Have you had botox in the last 3 weeks?*
No
Yes
Do you have excessively oily/dry skin?*
No
Yes, DRY
Yes, OILY
Do you have any skin conditions such as eczema?*
No
Yes
Do you agree to the fees discussed?*
No
Yes
There is a possibility of an allergic retain of pigments. A path test if advisable however it does not ensure a client will not have an allergic reaction. Patch test: (You MUST make a separate appointment if you would like a patch test and wait 3 weeks for results)*

If waived, I release the technician and assistants from liability if I develop an allergic reaction to the pigment. (Pigments contents are: iron oxide, lakes, alcohol, Glycerin and distilled. Sterile water) I acknowledge that NO GUARANTEES have been made to me concerning the results of this procedure. For the purpose of documentation, I also consent to the technician, salon or clinic. Laser treatments or ANY kind of facial injections may also compromise your permanent cosmetic makeup application.

I have read the above and had explained to me and fully understand this consent and procedure form: that the explanations therein referred to, were made, and I accept full responsibility for these or any other complications which may arise from results during or following that cosmetic procedure which is to be performed at my request according to this consent and procedure form. I also understand that this procedure is permanent.

I will follow all After Care instructions explicitly. Failing to do so will compromise my final results. 





I fully understand that a deposit of a $100 is required to schedule an appointment and is non-refundable. 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 $150 charge depending upon the amount of work needed. 




Please select all that apply : I request semi-permanent cosmetic make-up procedures *
BeYou Brow's Shaping
BrowsUp Lamination
GrowUp Brows (hair grow treatment)
Hydra Color Lips (hydration+temporary color)
Lash Lifting Tint
NanoLip Blushing
Nanoblading Eyebrows
Nanoshading Eyebrows (nanoblading + shading)

Medical consent and Procedure Chart 

If you are now taking or recently have taken any of these drugs, please select below. You may need a physician's release prior to your procedure.
Accutane
Anti- anxiety drugs
Antibiotics
Anticoagulants
Arthritis preparations
Aspirin
Blood pressure meds
Blood thinners
Diabetic meds
Heart meds
Hormones
Insulin injections
Meds for depression
Meds for mood change
Pain or headache meds
Seizure meds
Steroid preparations
tranquilizers
Please select if you have or had recently any of the following. You may need a physician's release prior to your procedure:
Accutane
Allergies to make-up
Alopecia
Anemia
Arthritis
Asthma
Autoimmune disorders
Blister on lips
Cancer (any type)
Chemical peels
Chest pains
Collagen injections
Cortisone
Diabetes
Dry eyes
Epilepsy/seizures
Excessive bleeding
Glaucoma
Gortex
Heart Conditions
Hepatitis/HIV
Herpes
Hyper-pigmentation
Hypertension
Jaundice
Keloid or hypertrophy scars
Kidney disease
Pacemaker
Refractive eye surgery
Shortness of breath
Sinus infections
Stroke
Tendency to develop fever
Trichotillomania
Could you possibly be pregnant?*
No
Yes
Are you nursing mother?*
No
Yes
Do you have any allergies to any medication?*
No
Yes
Novocain, Lidocaine or any topical anesthetics?*
No
Yes
Will you be on your menstrual cycle during the procedure?*
No
Yes
Do you smoke?*
No
Yes
What position do you sleep?
Facing down
Facing up
Left side
Right side
Have you ever had any permanent cosmetics applied on your Brows or Lips?*
No
Yes, Brows
Yes, Lips
Was pigment disposed of after your procedure was complete?*
Yes
Did you sign any Consent and Release forms?*
Yes

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 procedures(s) which is to be performed at my request according to this consent were filled in before I signed this statement. 

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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!