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PLEASE READ THOROUGHLY PRIOR TO SUBMITTING YOUR WAIVER!! FAILURE TO COMPLETE CORRECTLY WILL BE A $10 EXTRA CHARGE IF YOU HAVE TO FILL IT OUT AGAIN. Please complete and submit this form directly after booking your microblading, powder brow, or colorboost appointments. This MUST be filled out and completed PRIOR TO YOUR APPOINTMENT to ensure you are a candidate for permanent makeup services! Thank you!



First Client's Name

First Name*

Middle Name

Last Name*

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

Date of Scheduled Appointment *

Email Address *
Check list of things NOT to do/take at least 48 hours to 2 weeks prior to your appointment. *
By checking the boxes below next to each statement, I confirm that I have read and fully understand each item/statement made and that I am solely and personally responsible for avoiding or undertaking the following actions to ensure my own safety.
I understand I cannot drink alcohol or caffeine at least 24 hours before appointment.
I understand I cannot take ibuprofen, aspirin, fish oil or any other medications that will thin my blood at least 48 hours before my appointment.
I understand I should not take or self tan at least 2 weeks prior to my appointment. If self tanning please avoid the face area as we want to see your natural skin tone as much as possible.
I understand I need to come to my appointment with no makeup on
I understand I should not wax, tweeze, thread or remove any brow hair for at least 2 weeks before your appointment. We will need to see where all of your hair growth is.
I understand I cannot get botox for at least 2 weeks prior to my appointment.
I am aware of, and I agree to the following: The Microblading, or Powder Brows procedure, is a type of cosmetic tattooing. Usually, the healing period lasts between 2-4 weeks. A second visit is usually required thereafter at about 6 weeks. In some cases, more visits may be needed. During the healing period, redness, swelling, scabbing of the kind, irritation, itching, minor bleeding, and other effects may occur. I am aware that the final result will be achieved anywhere from 6-8 weeks following my last visit. *
Yes, I am aware, agree and acknowledge.
No
I am aware that the results of this desired cosmetic procedure can be affected by the following items or actions, including, but not limited to, medications, skin type, smoking, drug and alcohol use, the use of cosmetic skin care products and makeup on the eyebrow area, activities causing sweating or perspiration, eyebrow plucking, cosmetic surgery, and use of cosmetic injections. Further, I understand that if I am on any medications that I believe may impact the results of this cosmetic procedure, that it is my responsibility to consult a doctor prior to proceeding with any procedure *
Yes I am aware, agree and acknowledge.
No
I am aware that the results can be affected by: medication, skin type, smoking, drug and alcohol use, use of cosmetic skin care products and makeup on the eyebrow area, activities causing sweating, eyebrow plucking, cosmetic surgery, use of cosmetic injections and many other factors.*
Yes I am aware, agree and acknowledge.
No
I am aware that the pigments after initial procedure may partially and/or fully fade and/or disappear and full success cannot be guaranteed which is why the second visit (touch up) is highly recommended. I am aware that if I do not complete the process by scheduling and coming to the 6 week touch up, my results may not last the 1-3 years or longer that I was originally made aware of. I am aware that by not completing the touch up my results may only last (but not limited to) up to 6 months or less.*
Yes I am aware, agree and acknowledge.
No
I acknowledge that the final color and shade will be achieved after 6-8 weeks after the touch up and the pigment colors and shade may vary with time.*
Yes, I am aware, agree and acknowledge.
No
I understand that in some cases, numbing topical cream may be necessary. I further understand that it may cause some level of sensitivity, discomfort, allergic reaction, redness, swelling or other reactions, depending on the skin type and sensitivity*
Yes, I am aware, agree and acknowledge
No
I am aware of the risks of possible allergic reactions, infections and any other complications as a result of the procedure, especially if I do not take care of the eyebrows or follow proper aftercare instructions, and the skin in that area. In extremely rare cases some scarring is possible. I accept such risks and accept full responsibility for any post treatment complication. I informed the practitioner of my known allergies.*
Yes I am aware, agree and acknowledge
No
I acknowledge that the correcting and the revision of any type of existing permanent makeup, tattoo etc, previously performed by other providers involves additional risks due to unknown factors, such as but not limited to, brand, color, time, skin reaction, depth and others and the practitioner has no full control over the potential results and I accept full responsibility for the final outcome and complications.*
Yes I am aware, agree and acknowledge
No
I understand the following medical conditions require consent from the doctor:Diabetes, HIV, hepatitis, high blood pressure, thyroid disease, herpes, have a history of MRSA or staph infection, have any type of abnormal heart conditions, any type of autoimmune disorders, have any type of blood diseases, have glaucoma, have trichotillomania, alopecia, hemophilia, leukemia, anemia and any other blood disorders, any type of cancer, nursing and any type of liver disorders, have had any type of surgeries in the past 12 months, or under a doctors care for any particular condition. I will not hold Katie Riddle ( beautybykatiellc) liable if I choose not to get consent from my doctor. I am aware I cannot get microblading/powder brows if I am pregnant.*
I am aware/agree and acknowledge and do NOT have any of these conditions that I need to get consent from my doctors approval for.
I will need to get consent from my doctor for one or more of these conditions and will let my artist know upon approval/ disapproval as soon as possible before my appointment to avoid last minute cancellations due to the possibility of non approval from my doctor. I am aware that any last minute cancellations due to disapproval is still subject to cancellation fees within 48 hours.
I am aware that I will have the opportunity to approve the shape created by my artist provider before doing anything permanent therefore if I am unhappy with the shape, I am fully aware that I approved it before beginning. I give my consent to use Permanent Makeup tools/machine to apply pigments into my skin in the eyebrow area and modify the look of my existing eyebrows.*
Yes I am aware, agree and acknowledge.
No
I hereby agree that I will not make any oral or written statement about my artist provider, her business, or staff, which is intended or reasonably likely to disparage her, her business, or any of her staff members, or that degrades her, its, their, reputation(s) in any way. This includes, but is not limited to, any disparaging oral or written statements posted on social media platforms.*
Yes I am aware, agree, and acknowledge.
No
I consent or waive the patch test. If waived, I release the technician from liability if I develop an allergic reaction to the pigments or products. A Patch test is where we take a small amount of the products we would use for the permanent makeup procedure and dot a few spots behind your ear, in your hair line. -I understand that allergic reactions such as stinging or burning sensations on the treating area or surrounding area, including the eyes, may occur. -I understand that an allergic reaction can occur at any time, even if I have received this service on previous occasions. -I understand that if I develop any allergic reaction, I must rinse with cold water, avoid using perfume or makeup products on the area, and should seek immediate medical attention. - I understand that a negative patch test does not guarantee that I will not have an adverse reaction to services performed.*
I would like a patch test prior to my appointment and understand this must be done 48 hours prior to my appointment and will reach out to Katie about doing the patch test.
I do not want a patch test.
I am over the age of 18*
No
Yes
I have not gotten botox in or around my face or head in 2 weeks and am aware that if I am dishonest about this that it can alter my microblading/powder brow results/shape. I agree I will not get Botox for at least 2 weeks prior to my appointment.*
No, I have to get Botox 2 weeks prior and am aware this will mean the cancelation of my PMU appointment.
Yes I am aware, agree and acknowledge that I cannot and will not get botox 2 weeks prior to my appointment.
The client fully, and voluntarily, consents to have the Specialist perform the permanent cosmetic procedure(s), and is fully aware and informed of all and any inherent risks, dangers, and complications associated with having permanent cosmetic facial tattoo procedures performed. The client has had any questions or concerns which he/she has expressed satisfactorily answered or resolved by the Specialist.*
Yes I am aware, agree and acknowledge.
No
The Client, realizing that cosmetic procedures of the type of those specified in this agreement are fraught with risks and dangers which cannot be eliminated from the process regardless of the precautions and safeguards which are undertaken, hereby agrees that the client releases the Specialist from any and all claims, damages, and liability of all types relating to the performance of the specified procedure(s), including any costs of medical care or assistance required by the Client as a result of the procedure(s) performed, which shall include any post-operative care, repair or reconstruction which the Client may require or desire. This release agreement by the client shall also extend to the proprietors, officers, agents, and employees of any business Specialist that is employed by or associated with performing the cosmetic procedure(s)*
Yes I am aware, agree and acknowledge.
No
I acknowledge it is not reasonably possible for the representatives and employees of this permanent makeup salon to determine whether I might have an allergic reaction to the pigments or processes used in my procedure, and I agree to accept the risk that such a reaction is possible. I am aware I will not receive ANY refunds for any allergic reaction to the PMU procedure.*
Yes I am aware, agree and acknowledge
No
I acknowledge that infection is always possible as a result of the obtaining of a permanent makeup, particularly in the event that I do not take proper care of my permanent makeup. I have received aftercare instructions and I agree to follow them carefully while my permanent makeup is healing. I agree that any touch-up work needed outside of the normal 6 week touch up, due to my own negligence, will be done at my own expense. I understand that if I do not follow the aftercare instructions carefully at my own negligence, my results may not be what was expected and I will not hold my artist responsible for such actions that were done by me.*
Yes I am aware, agree and acknowledge
No
I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my permanent makeup .*
Yes I am aware, agree and acknowledge
No
I understand that it is necessary for me to let my brow hair grow out as much as possible and I agree that I will not pluck, thread, wax, or remove any hair at least 2 weeks prior to my appointment. This is necessary to getting the proper shape for your brow and to avoid applying too much strokes/shading in areas that do naturally grow hair. I understand and am aware that if I do not follow this advice I may have less than satisfied results and will not blame my artist.*
Yes I am aware, agree and acknowledge.
No
I agree to release and forever discharge and hold harmless the Artist and all employees from any and all claims, damages or legal actions arising from or connected in any way with my permanent makeup , or the procedure and conduct used in my permanent makeup .*
Yes I am aware, agree and acknowledge.
No
I am aware that I cannot get the procedure done if I have been to the tanning bed/ or had natural sun at least two weeks or less prior to my appointment or if I have self tanner on my face at the appointment. Some tan is fine but we want to see your natural skin tone as much as possible so please do not lay out, go to the tanning bed, or self tan/spray tan for at least 2 weeks prior to your permanent makeup appointment.*
Yes I am aware, agree and acknowledge
No
I am aware that I cannot take any blood thinning medications such as Aspirin, Ibuprofen, Alcohol, Coumadin ect, at least 48 hours prior to my appointment. I am aware that by doing so this can affect the shape and healed results if too much blood is covering the pre-dran shade during the procedure. This could even result in the artist being forced to stop the procedure and reschedule your appointment. In a rare case as this, the cancelation fee would apply for the current appointment and a new full charge appointment will be necessary to complete the service.*
Yes I am aware, agree and acknowledge
No
I understand that it is my responsibility to ask questions about any information contained herein that I do not understand or is confusing to me and that I must do so prior to submitting this form. I understand that my submission of this form represents that I did not have any questions and that I fully understand all content. If I arrive to my appointment with anything that would prohibit my artist to proceed with the procedure, I hereby agree to pay a cancellation fee amounting to 35% of the services I booked which is due to my artist prior to leaving the scheduled appointment. If this should happen, I understand that I will need to reschedule my appointment for a later date and take any action necessary prior to me rescheduling my appointment.*
No
Yes I am aware, agree and acknowledge
Clients Medical History/misc. PLEASE ONLY CLICK THE BOXES IF YOU ARE ANSWERING YES TO THE QUESTION. by not clicking the boxes you are answering no.
Do you have a history of MRSA?
Have you/ will you have had Botox 2 weeks or sooner to your appointment?
Do you have diabetes?
Do you have hepatitis A B C D?
Have you had a brow lift or facelift?
Do you typically bleed easily?
Are you/ will you be under the influence of alcohol or drugs during your appointment?
Do you have any abnormal heart conditions?
Do you take medication before dental work?
Have you/will you have had a chemical peel within two weeks from your PMU appointment?
Are you pregnant or breatfeeding?
Have you had any brow or lash tinting?
Do you have an autoimmune disorder?
Are you currently being treated for cancer or been treated for it in the last 12 months?
Are you currently taking Accutane or acne treatments?
Are you under treatment of chemotherapy or radiation?
Do you have any tumors or cysts?
Have you/ will you have taken any blood thinning medications such as; Aspirin, Ibuprofen, Alcohol, Coumadin etc 48 hour or less than before your appointment?
Have you ever had any Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylene Glycol, Vitamin E Acetate, etc?
Do you use skin care products containing Retin-A, Glycolic Acid, or Alpha Hydroxyl? Please do not use these 48 hours prior to your appointment to avoid sensitivity.
Do you have any heart conditions?
Do you have a mitral or prolapsed heart valve
Do you have any joint replacements?
Do you have any type of blood diseases?
Are you hemophiliac?
Are you epileptic or subject to seizures?
Do you have glaucoma?
Do you have any dermatological disorders (eczema, rosacea, psoriasis, dermatitis, shingles, etc.)
Do you have herpes?
Do you have (or are you prone to) keloid formation?
Do you have trichotillomania?
Do you have alopecia?
Do you use steroids?
Do you have Tourette's syndrome or are you prone to nervous ticks?
Are you planning to have any cosmetic or other surgeries for at least 3 months after your appointment?
Do you have other tattoos?
I agree that I have answered all of the above questions truthfully and to the best of my knowledge. I understand that if I did not, anything can pose a risk to my permanent makeup procedure and could alter my results, resulting in infection or other possible risks. I understand that if I did not, and come to my appointment with anything that would prohibit my artist to proceed with the procedure that a cancellation fee of 35% of the service booked will be due before leaving the appointment and I will need to reschedule to a later date and/or take any action necessary before rescheduling, based on the case.*
Yes I am aware, agree and acknowledge.
No
Post Procedure Care for PMU Procedure. Results vary based on the "canvas" (your skin) that they are performed on. Lifestyle, medications, smoking, metabolism, facial surgery and other procedures, and age of skin all contribute to fading, color change over time. In some cases PMU can turn red, blue, or other colors depending on your skin and how it heals. There are color correctors that can fix the discoloration over time. I understand that I accept such risks. Though rare, infection is possible. If you see signs of infection such as persistent increased redness or swelling, fever, drainage, or oozing, contact your doctor immediately. When the area starts to flake, leave it. Do not pick, peel or pull on the skin whatsoever. Let the scabs or flakes come off naturally on its own.• Wash area lightly with mild foamy soap and finger tips every 3 hours, 2-3 times for the first day directly after the procedure, pat dry well, then apply a very thin layer of aftercare ointment (provided to you by your technician) to the area as advised. Day 2, wash the area lightly only morning and night, pat dry well, then apply a very thin layer or healing ointment. Day 3 STOP THE CLEANING, and only use the healing ointment morning, afternoon, and night as needed. If you apply it in the morning and by the afternoon there is still ointment on there, there is no need to reapply it. Over applying the healing ointment or putting too much on can cause your results to blur or heal correctly. It's very important to only apply a very very thin layer of ointment when using the healing ointment. Continue applying the healing ointment (morning, afternoon and night as needed) from day 4 and on for about 3 weeks or until healed. You should have enough healing ointment for your healing process after the first appointment AND for your healing process after the 6 week touch up which will be the same healing process/aftercare instructions. This will help you realize how little ointment you need to use and to not over apply. • Avoid sweating such as from vigorous exercise for 3 weeks. For at least 2/3 weeks post-procedure or until healing is complete: Keep your hands clean and avoid touching the affected area(s). Do not scrub or pick treated areas, Do not use peroxide or Neosporin on treated areas, Do not expose area to direct sun or to tanning beds, Avoid exposing the area to excessive moisture or humidity, such as: facials, swimming, whirlpools (hot tubs), saunas, steam rooms, and steamy showers. • Avoid Retin-A, moisturizers, glycolic acids, exfoliants and anti-aging products at all times (not just during healing) on all microbladed/shaded areas. These can cause pigments to fade and lighten prematurely. • Avoid tanning beds, sun, chlorine spas and pools, soap and chemicals (including skin cleansers, makeupremovers, alpha hydroxyl creams, and tooth whitening toothpaste) near the treated area until healed. • Pigments will slowly fade overtime according to one's metabolism, skin type, sun exposure, medication, facial surgery, and smoking. Schedule maintenance visits as needed to keep it looking fresh (no sooner than 12-18 months from your original appointment). • Periodic colorboosts will ensure longer lasting results however getting a colorboost too soon is unnecessary. If you're unsure if you're ready for a colorboost please contact me directly and send photos of your current brows. • Do not resume any method of eyebrow hair removal or coloration for at least 3 weeks. • Avoid eyebrow tinting within two weeks before or after the procedure. Do not apply any makeup, self tanners, spray tan, sunscreen or any other facial products, ect on or around your brows for at least 3-4 weeks until healed. Do not get them wet or sweat on them for at least 3-4 weeks until healed. I agree that I have been made aware of the aftercare instructions and have read through thoroughly. I am aware that by not following the aftercare instructions carefully, that it can alter my healed results due to my own negligence. You will also be given these instructions verbally at your appointment and can ask any questions at the appointment about the aftercare. I agree I have read and agree to follow these instructions carefully.*
Yes I have read and understand/agree with the above information.
No
Microblading/powder brow Healing scheduleOne of the most common questions we're asked is what to expect during the healing process. While every person is different and some heal more quickly or slowly than others, here's generally what to expect. Temporary side effects from micropigmentation include but are not limited to: redness, swelling, puffiness, bruising, dry patches and tenderness. You should expect to lose approximately 1/3 of the initial color during the healing process. We have selected the optimal pigments for you with this in mind. The first couple of days they may get extremely dark. In approximately six days or more it may appear too light. After about 10 days, the color will show more. It will appear softer when completely healed. Day 1 The eyebrows are approximately 20- 25% bolder and darker in width than they will be when healed. Expect light to moderate swelling and redness. The skin's redness causes the color of the pigment to appear darker. There is some swelling, although difficult to actually see due to the thickness of the skin in the eyebrow area. This will subside. New skin will heal over the pigmented area and result in a softer appearance of your eyebrows. Don't be concerned that your eyebrows initially appear darker and heavier in size than you desire. This is all part of the process. Eyebrows may start to itch. The skin begins to flake, peeling from the outside edges first. Color finishes flaking off and appears softer and grayer for a few days until color clarifies. The color has lightened from its initial overly-dark appearance. For the next few days, the color may now be lighter than what the final color will be. The final color begins to stabilize and show through. The color will continue to soften as the healing process completes. I UNDERSTAND AND ACCEPT THAT FAILURE TO FOLLOW THE POST-PROCEDURE INSTRUCTIONS ABOVE MAY RESULT IN A LOSS OR DISCOLORATION OF PIGMENT RESULTING IN A NEED FOR MORE FREQUENT TOUCHUPS OR LESS THAN DESIRED RESULTS. I agree I have read through this carefully.*
Yes I am aware, agree, acknowledge and understand the above information.
No
The Client acknowledges receipt of pre-procedure information and post-procedure (aftercare) instructions from the Specialist, and agrees that they have read them, have been advised of them, understand them, and agree to adhere to them in order to help ensure satisfactory results from the procedure(s) and help prevent secondary infection. The Client acknowledges that all final adjustments and detail work will be done in the second session, and will schedule a follow-up session with the Specialist 6 weeks of the procedure(s).*
Yes I am aware, agree and acknowledge
No

By signing below this line, I acknowledge that I have thoroughly read the entirety of this form, that I understand the terms contained herein, that I agree to adhere to any and all pre and post procedure directions, and that my answers were accurate and honest.
First Client's Signature*
Second Client's Name

First Name*

Middle Name

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

Date of Scheduled Appointment *

Email Address *
Check list of things NOT to do/take at least 48 hours to 2 weeks prior to your appointment. *
By checking the boxes below next to each statement, I confirm that I have read and fully understand each item/statement made and that I am solely and personally responsible for avoiding or undertaking the following actions to ensure my own safety.
I understand I cannot drink alcohol or caffeine at least 24 hours before appointment.
I understand I cannot take ibuprofen, aspirin, fish oil or any other medications that will thin my blood at least 48 hours before my appointment.
I understand I should not take or self tan at least 2 weeks prior to my appointment. If self tanning please avoid the face area as we want to see your natural skin tone as much as possible.
I understand I need to come to my appointment with no makeup on
I understand I should not wax, tweeze, thread or remove any brow hair for at least 2 weeks before your appointment. We will need to see where all of your hair growth is.
I understand I cannot get botox for at least 2 weeks prior to my appointment.
I am aware of, and I agree to the following: The Microblading, or Powder Brows procedure, is a type of cosmetic tattooing. Usually, the healing period lasts between 2-4 weeks. A second visit is usually required thereafter at about 6 weeks. In some cases, more visits may be needed. During the healing period, redness, swelling, scabbing of the kind, irritation, itching, minor bleeding, and other effects may occur. I am aware that the final result will be achieved anywhere from 6-8 weeks following my last visit. *
Yes, I am aware, agree and acknowledge.
No
I am aware that the results of this desired cosmetic procedure can be affected by the following items or actions, including, but not limited to, medications, skin type, smoking, drug and alcohol use, the use of cosmetic skin care products and makeup on the eyebrow area, activities causing sweating or perspiration, eyebrow plucking, cosmetic surgery, and use of cosmetic injections. Further, I understand that if I am on any medications that I believe may impact the results of this cosmetic procedure, that it is my responsibility to consult a doctor prior to proceeding with any procedure *
Yes I am aware, agree and acknowledge.
No
I am aware that the results can be affected by: medication, skin type, smoking, drug and alcohol use, use of cosmetic skin care products and makeup on the eyebrow area, activities causing sweating, eyebrow plucking, cosmetic surgery, use of cosmetic injections and many other factors.*
Yes I am aware, agree and acknowledge.
No
I am aware that the pigments after initial procedure may partially and/or fully fade and/or disappear and full success cannot be guaranteed which is why the second visit (touch up) is highly recommended. I am aware that if I do not complete the process by scheduling and coming to the 6 week touch up, my results may not last the 1-3 years or longer that I was originally made aware of. I am aware that by not completing the touch up my results may only last (but not limited to) up to 6 months or less.*
Yes I am aware, agree and acknowledge.
No
I acknowledge that the final color and shade will be achieved after 6-8 weeks after the touch up and the pigment colors and shade may vary with time.*
Yes, I am aware, agree and acknowledge.
No
I understand that in some cases, numbing topical cream may be necessary. I further understand that it may cause some level of sensitivity, discomfort, allergic reaction, redness, swelling or other reactions, depending on the skin type and sensitivity*
Yes, I am aware, agree and acknowledge
No
I am aware of the risks of possible allergic reactions, infections and any other complications as a result of the procedure, especially if I do not take care of the eyebrows or follow proper aftercare instructions, and the skin in that area. In extremely rare cases some scarring is possible. I accept such risks and accept full responsibility for any post treatment complication. I informed the practitioner of my known allergies.*
Yes I am aware, agree and acknowledge
No
I acknowledge that the correcting and the revision of any type of existing permanent makeup, tattoo etc, previously performed by other providers involves additional risks due to unknown factors, such as but not limited to, brand, color, time, skin reaction, depth and others and the practitioner has no full control over the potential results and I accept full responsibility for the final outcome and complications.*
Yes I am aware, agree and acknowledge
No
I understand the following medical conditions require consent from the doctor:Diabetes, HIV, hepatitis, high blood pressure, thyroid disease, herpes, have a history of MRSA or staph infection, have any type of abnormal heart conditions, any type of autoimmune disorders, have any type of blood diseases, have glaucoma, have trichotillomania, alopecia, hemophilia, leukemia, anemia and any other blood disorders, any type of cancer, nursing and any type of liver disorders, have had any type of surgeries in the past 12 months, or under a doctors care for any particular condition. I will not hold Katie Riddle ( beautybykatiellc) liable if I choose not to get consent from my doctor. I am aware I cannot get microblading/powder brows if I am pregnant.*
I am aware/agree and acknowledge and do NOT have any of these conditions that I need to get consent from my doctors approval for.
I will need to get consent from my doctor for one or more of these conditions and will let my artist know upon approval/ disapproval as soon as possible before my appointment to avoid last minute cancellations due to the possibility of non approval from my doctor. I am aware that any last minute cancellations due to disapproval is still subject to cancellation fees within 48 hours.
I am aware that I will have the opportunity to approve the shape created by my artist provider before doing anything permanent therefore if I am unhappy with the shape, I am fully aware that I approved it before beginning. I give my consent to use Permanent Makeup tools/machine to apply pigments into my skin in the eyebrow area and modify the look of my existing eyebrows.*
Yes I am aware, agree and acknowledge.
No
I hereby agree that I will not make any oral or written statement about my artist provider, her business, or staff, which is intended or reasonably likely to disparage her, her business, or any of her staff members, or that degrades her, its, their, reputation(s) in any way. This includes, but is not limited to, any disparaging oral or written statements posted on social media platforms.*
Yes I am aware, agree, and acknowledge.
No
I consent or waive the patch test. If waived, I release the technician from liability if I develop an allergic reaction to the pigments or products. A Patch test is where we take a small amount of the products we would use for the permanent makeup procedure and dot a few spots behind your ear, in your hair line. -I understand that allergic reactions such as stinging or burning sensations on the treating area or surrounding area, including the eyes, may occur. -I understand that an allergic reaction can occur at any time, even if I have received this service on previous occasions. -I understand that if I develop any allergic reaction, I must rinse with cold water, avoid using perfume or makeup products on the area, and should seek immediate medical attention. - I understand that a negative patch test does not guarantee that I will not have an adverse reaction to services performed.*
I would like a patch test prior to my appointment and understand this must be done 48 hours prior to my appointment and will reach out to Katie about doing the patch test.
I do not want a patch test.
I am over the age of 18*
No
Yes
I have not gotten botox in or around my face or head in 2 weeks and am aware that if I am dishonest about this that it can alter my microblading/powder brow results/shape. I agree I will not get Botox for at least 2 weeks prior to my appointment.*
No, I have to get Botox 2 weeks prior and am aware this will mean the cancelation of my PMU appointment.
Yes I am aware, agree and acknowledge that I cannot and will not get botox 2 weeks prior to my appointment.
The client fully, and voluntarily, consents to have the Specialist perform the permanent cosmetic procedure(s), and is fully aware and informed of all and any inherent risks, dangers, and complications associated with having permanent cosmetic facial tattoo procedures performed. The client has had any questions or concerns which he/she has expressed satisfactorily answered or resolved by the Specialist.*
Yes I am aware, agree and acknowledge.
No
The Client, realizing that cosmetic procedures of the type of those specified in this agreement are fraught with risks and dangers which cannot be eliminated from the process regardless of the precautions and safeguards which are undertaken, hereby agrees that the client releases the Specialist from any and all claims, damages, and liability of all types relating to the performance of the specified procedure(s), including any costs of medical care or assistance required by the Client as a result of the procedure(s) performed, which shall include any post-operative care, repair or reconstruction which the Client may require or desire. This release agreement by the client shall also extend to the proprietors, officers, agents, and employees of any business Specialist that is employed by or associated with performing the cosmetic procedure(s)*
Yes I am aware, agree and acknowledge.
No
I acknowledge it is not reasonably possible for the representatives and employees of this permanent makeup salon to determine whether I might have an allergic reaction to the pigments or processes used in my procedure, and I agree to accept the risk that such a reaction is possible. I am aware I will not receive ANY refunds for any allergic reaction to the PMU procedure.*
Yes I am aware, agree and acknowledge
No
I acknowledge that infection is always possible as a result of the obtaining of a permanent makeup, particularly in the event that I do not take proper care of my permanent makeup. I have received aftercare instructions and I agree to follow them carefully while my permanent makeup is healing. I agree that any touch-up work needed outside of the normal 6 week touch up, due to my own negligence, will be done at my own expense. I understand that if I do not follow the aftercare instructions carefully at my own negligence, my results may not be what was expected and I will not hold my artist responsible for such actions that were done by me.*
Yes I am aware, agree and acknowledge
No
I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my permanent makeup .*
Yes I am aware, agree and acknowledge
No
I understand that it is necessary for me to let my brow hair grow out as much as possible and I agree that I will not pluck, thread, wax, or remove any hair at least 2 weeks prior to my appointment. This is necessary to getting the proper shape for your brow and to avoid applying too much strokes/shading in areas that do naturally grow hair. I understand and am aware that if I do not follow this advice I may have less than satisfied results and will not blame my artist.*
Yes I am aware, agree and acknowledge.
No
I agree to release and forever discharge and hold harmless the Artist and all employees from any and all claims, damages or legal actions arising from or connected in any way with my permanent makeup , or the procedure and conduct used in my permanent makeup .*
Yes I am aware, agree and acknowledge.
No
I am aware that I cannot get the procedure done if I have been to the tanning bed/ or had natural sun at least two weeks or less prior to my appointment or if I have self tanner on my face at the appointment. Some tan is fine but we want to see your natural skin tone as much as possible so please do not lay out, go to the tanning bed, or self tan/spray tan for at least 2 weeks prior to your permanent makeup appointment.*
Yes I am aware, agree and acknowledge
No
I am aware that I cannot take any blood thinning medications such as Aspirin, Ibuprofen, Alcohol, Coumadin ect, at least 48 hours prior to my appointment. I am aware that by doing so this can affect the shape and healed results if too much blood is covering the pre-dran shade during the procedure. This could even result in the artist being forced to stop the procedure and reschedule your appointment. In a rare case as this, the cancelation fee would apply for the current appointment and a new full charge appointment will be necessary to complete the service.*
Yes I am aware, agree and acknowledge
No
I understand that it is my responsibility to ask questions about any information contained herein that I do not understand or is confusing to me and that I must do so prior to submitting this form. I understand that my submission of this form represents that I did not have any questions and that I fully understand all content. If I arrive to my appointment with anything that would prohibit my artist to proceed with the procedure, I hereby agree to pay a cancellation fee amounting to 35% of the services I booked which is due to my artist prior to leaving the scheduled appointment. If this should happen, I understand that I will need to reschedule my appointment for a later date and take any action necessary prior to me rescheduling my appointment.*
No
Yes I am aware, agree and acknowledge
Clients Medical History/misc. PLEASE ONLY CLICK THE BOXES IF YOU ARE ANSWERING YES TO THE QUESTION. by not clicking the boxes you are answering no.
Do you have a history of MRSA?
Have you/ will you have had Botox 2 weeks or sooner to your appointment?
Do you have diabetes?
Do you have hepatitis A B C D?
Have you had a brow lift or facelift?
Do you typically bleed easily?
Are you/ will you be under the influence of alcohol or drugs during your appointment?
Do you have any abnormal heart conditions?
Do you take medication before dental work?
Have you/will you have had a chemical peel within two weeks from your PMU appointment?
Are you pregnant or breatfeeding?
Have you had any brow or lash tinting?
Do you have an autoimmune disorder?
Are you currently being treated for cancer or been treated for it in the last 12 months?
Are you currently taking Accutane or acne treatments?
Are you under treatment of chemotherapy or radiation?
Do you have any tumors or cysts?
Have you/ will you have taken any blood thinning medications such as; Aspirin, Ibuprofen, Alcohol, Coumadin etc 48 hour or less than before your appointment?
Have you ever had any Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylene Glycol, Vitamin E Acetate, etc?
Do you use skin care products containing Retin-A, Glycolic Acid, or Alpha Hydroxyl? Please do not use these 48 hours prior to your appointment to avoid sensitivity.
Do you have any heart conditions?
Do you have a mitral or prolapsed heart valve
Do you have any joint replacements?
Do you have any type of blood diseases?
Are you hemophiliac?
Are you epileptic or subject to seizures?
Do you have glaucoma?
Do you have any dermatological disorders (eczema, rosacea, psoriasis, dermatitis, shingles, etc.)
Do you have herpes?
Do you have (or are you prone to) keloid formation?
Do you have trichotillomania?
Do you have alopecia?
Do you use steroids?
Do you have Tourette's syndrome or are you prone to nervous ticks?
Are you planning to have any cosmetic or other surgeries for at least 3 months after your appointment?
Do you have other tattoos?
I agree that I have answered all of the above questions truthfully and to the best of my knowledge. I understand that if I did not, anything can pose a risk to my permanent makeup procedure and could alter my results, resulting in infection or other possible risks. I understand that if I did not, and come to my appointment with anything that would prohibit my artist to proceed with the procedure that a cancellation fee of 35% of the service booked will be due before leaving the appointment and I will need to reschedule to a later date and/or take any action necessary before rescheduling, based on the case.*
Yes I am aware, agree and acknowledge.
No
Post Procedure Care for PMU Procedure. Results vary based on the "canvas" (your skin) that they are performed on. Lifestyle, medications, smoking, metabolism, facial surgery and other procedures, and age of skin all contribute to fading, color change over time. In some cases PMU can turn red, blue, or other colors depending on your skin and how it heals. There are color correctors that can fix the discoloration over time. I understand that I accept such risks. Though rare, infection is possible. If you see signs of infection such as persistent increased redness or swelling, fever, drainage, or oozing, contact your doctor immediately. When the area starts to flake, leave it. Do not pick, peel or pull on the skin whatsoever. Let the scabs or flakes come off naturally on its own.• Wash area lightly with mild foamy soap and finger tips every 3 hours, 2-3 times for the first day directly after the procedure, pat dry well, then apply a very thin layer of aftercare ointment (provided to you by your technician) to the area as advised. Day 2, wash the area lightly only morning and night, pat dry well, then apply a very thin layer or healing ointment. Day 3 STOP THE CLEANING, and only use the healing ointment morning, afternoon, and night as needed. If you apply it in the morning and by the afternoon there is still ointment on there, there is no need to reapply it. Over applying the healing ointment or putting too much on can cause your results to blur or heal correctly. It's very important to only apply a very very thin layer of ointment when using the healing ointment. Continue applying the healing ointment (morning, afternoon and night as needed) from day 4 and on for about 3 weeks or until healed. You should have enough healing ointment for your healing process after the first appointment AND for your healing process after the 6 week touch up which will be the same healing process/aftercare instructions. This will help you realize how little ointment you need to use and to not over apply. • Avoid sweating such as from vigorous exercise for 3 weeks. For at least 2/3 weeks post-procedure or until healing is complete: Keep your hands clean and avoid touching the affected area(s). Do not scrub or pick treated areas, Do not use peroxide or Neosporin on treated areas, Do not expose area to direct sun or to tanning beds, Avoid exposing the area to excessive moisture or humidity, such as: facials, swimming, whirlpools (hot tubs), saunas, steam rooms, and steamy showers. • Avoid Retin-A, moisturizers, glycolic acids, exfoliants and anti-aging products at all times (not just during healing) on all microbladed/shaded areas. These can cause pigments to fade and lighten prematurely. • Avoid tanning beds, sun, chlorine spas and pools, soap and chemicals (including skin cleansers, makeupremovers, alpha hydroxyl creams, and tooth whitening toothpaste) near the treated area until healed. • Pigments will slowly fade overtime according to one's metabolism, skin type, sun exposure, medication, facial surgery, and smoking. Schedule maintenance visits as needed to keep it looking fresh (no sooner than 12-18 months from your original appointment). • Periodic colorboosts will ensure longer lasting results however getting a colorboost too soon is unnecessary. If you're unsure if you're ready for a colorboost please contact me directly and send photos of your current brows. • Do not resume any method of eyebrow hair removal or coloration for at least 3 weeks. • Avoid eyebrow tinting within two weeks before or after the procedure. Do not apply any makeup, self tanners, spray tan, sunscreen or any other facial products, ect on or around your brows for at least 3-4 weeks until healed. Do not get them wet or sweat on them for at least 3-4 weeks until healed. I agree that I have been made aware of the aftercare instructions and have read through thoroughly. I am aware that by not following the aftercare instructions carefully, that it can alter my healed results due to my own negligence. You will also be given these instructions verbally at your appointment and can ask any questions at the appointment about the aftercare. I agree I have read and agree to follow these instructions carefully.*
Yes I have read and understand/agree with the above information.
No
Microblading/powder brow Healing scheduleOne of the most common questions we're asked is what to expect during the healing process. While every person is different and some heal more quickly or slowly than others, here's generally what to expect. Temporary side effects from micropigmentation include but are not limited to: redness, swelling, puffiness, bruising, dry patches and tenderness. You should expect to lose approximately 1/3 of the initial color during the healing process. We have selected the optimal pigments for you with this in mind. The first couple of days they may get extremely dark. In approximately six days or more it may appear too light. After about 10 days, the color will show more. It will appear softer when completely healed. Day 1 The eyebrows are approximately 20- 25% bolder and darker in width than they will be when healed. Expect light to moderate swelling and redness. The skin's redness causes the color of the pigment to appear darker. There is some swelling, although difficult to actually see due to the thickness of the skin in the eyebrow area. This will subside. New skin will heal over the pigmented area and result in a softer appearance of your eyebrows. Don't be concerned that your eyebrows initially appear darker and heavier in size than you desire. This is all part of the process. Eyebrows may start to itch. The skin begins to flake, peeling from the outside edges first. Color finishes flaking off and appears softer and grayer for a few days until color clarifies. The color has lightened from its initial overly-dark appearance. For the next few days, the color may now be lighter than what the final color will be. The final color begins to stabilize and show through. The color will continue to soften as the healing process completes. I UNDERSTAND AND ACCEPT THAT FAILURE TO FOLLOW THE POST-PROCEDURE INSTRUCTIONS ABOVE MAY RESULT IN A LOSS OR DISCOLORATION OF PIGMENT RESULTING IN A NEED FOR MORE FREQUENT TOUCHUPS OR LESS THAN DESIRED RESULTS. I agree I have read through this carefully.*
Yes I am aware, agree, acknowledge and understand the above information.
No
The Client acknowledges receipt of pre-procedure information and post-procedure (aftercare) instructions from the Specialist, and agrees that they have read them, have been advised of them, understand them, and agree to adhere to them in order to help ensure satisfactory results from the procedure(s) and help prevent secondary infection. The Client acknowledges that all final adjustments and detail work will be done in the second session, and will schedule a follow-up session with the Specialist 6 weeks of the procedure(s).*
Yes I am aware, agree and acknowledge
No

By signing below this line, I acknowledge that I have thoroughly read the entirety of this form, that I understand the terms contained herein, that I agree to adhere to any and all pre and post procedure directions, and that my answers were accurate and honest.
Third Client's Name

First Name*

Middle Name

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

Date of Scheduled Appointment *

Email Address *
Check list of things NOT to do/take at least 48 hours to 2 weeks prior to your appointment. *
By checking the boxes below next to each statement, I confirm that I have read and fully understand each item/statement made and that I am solely and personally responsible for avoiding or undertaking the following actions to ensure my own safety.
I understand I cannot drink alcohol or caffeine at least 24 hours before appointment.
I understand I cannot take ibuprofen, aspirin, fish oil or any other medications that will thin my blood at least 48 hours before my appointment.
I understand I should not take or self tan at least 2 weeks prior to my appointment. If self tanning please avoid the face area as we want to see your natural skin tone as much as possible.
I understand I need to come to my appointment with no makeup on
I understand I should not wax, tweeze, thread or remove any brow hair for at least 2 weeks before your appointment. We will need to see where all of your hair growth is.
I understand I cannot get botox for at least 2 weeks prior to my appointment.
I am aware of, and I agree to the following: The Microblading, or Powder Brows procedure, is a type of cosmetic tattooing. Usually, the healing period lasts between 2-4 weeks. A second visit is usually required thereafter at about 6 weeks. In some cases, more visits may be needed. During the healing period, redness, swelling, scabbing of the kind, irritation, itching, minor bleeding, and other effects may occur. I am aware that the final result will be achieved anywhere from 6-8 weeks following my last visit. *
Yes, I am aware, agree and acknowledge.
No
I am aware that the results of this desired cosmetic procedure can be affected by the following items or actions, including, but not limited to, medications, skin type, smoking, drug and alcohol use, the use of cosmetic skin care products and makeup on the eyebrow area, activities causing sweating or perspiration, eyebrow plucking, cosmetic surgery, and use of cosmetic injections. Further, I understand that if I am on any medications that I believe may impact the results of this cosmetic procedure, that it is my responsibility to consult a doctor prior to proceeding with any procedure *
Yes I am aware, agree and acknowledge.
No
I am aware that the results can be affected by: medication, skin type, smoking, drug and alcohol use, use of cosmetic skin care products and makeup on the eyebrow area, activities causing sweating, eyebrow plucking, cosmetic surgery, use of cosmetic injections and many other factors.*
Yes I am aware, agree and acknowledge.
No
I am aware that the pigments after initial procedure may partially and/or fully fade and/or disappear and full success cannot be guaranteed which is why the second visit (touch up) is highly recommended. I am aware that if I do not complete the process by scheduling and coming to the 6 week touch up, my results may not last the 1-3 years or longer that I was originally made aware of. I am aware that by not completing the touch up my results may only last (but not limited to) up to 6 months or less.*
Yes I am aware, agree and acknowledge.
No
I acknowledge that the final color and shade will be achieved after 6-8 weeks after the touch up and the pigment colors and shade may vary with time.*
Yes, I am aware, agree and acknowledge.
No
I understand that in some cases, numbing topical cream may be necessary. I further understand that it may cause some level of sensitivity, discomfort, allergic reaction, redness, swelling or other reactions, depending on the skin type and sensitivity*
Yes, I am aware, agree and acknowledge
No
I am aware of the risks of possible allergic reactions, infections and any other complications as a result of the procedure, especially if I do not take care of the eyebrows or follow proper aftercare instructions, and the skin in that area. In extremely rare cases some scarring is possible. I accept such risks and accept full responsibility for any post treatment complication. I informed the practitioner of my known allergies.*
Yes I am aware, agree and acknowledge
No
I acknowledge that the correcting and the revision of any type of existing permanent makeup, tattoo etc, previously performed by other providers involves additional risks due to unknown factors, such as but not limited to, brand, color, time, skin reaction, depth and others and the practitioner has no full control over the potential results and I accept full responsibility for the final outcome and complications.*
Yes I am aware, agree and acknowledge
No
I understand the following medical conditions require consent from the doctor:Diabetes, HIV, hepatitis, high blood pressure, thyroid disease, herpes, have a history of MRSA or staph infection, have any type of abnormal heart conditions, any type of autoimmune disorders, have any type of blood diseases, have glaucoma, have trichotillomania, alopecia, hemophilia, leukemia, anemia and any other blood disorders, any type of cancer, nursing and any type of liver disorders, have had any type of surgeries in the past 12 months, or under a doctors care for any particular condition. I will not hold Katie Riddle ( beautybykatiellc) liable if I choose not to get consent from my doctor. I am aware I cannot get microblading/powder brows if I am pregnant.*
I am aware/agree and acknowledge and do NOT have any of these conditions that I need to get consent from my doctors approval for.
I will need to get consent from my doctor for one or more of these conditions and will let my artist know upon approval/ disapproval as soon as possible before my appointment to avoid last minute cancellations due to the possibility of non approval from my doctor. I am aware that any last minute cancellations due to disapproval is still subject to cancellation fees within 48 hours.
I am aware that I will have the opportunity to approve the shape created by my artist provider before doing anything permanent therefore if I am unhappy with the shape, I am fully aware that I approved it before beginning. I give my consent to use Permanent Makeup tools/machine to apply pigments into my skin in the eyebrow area and modify the look of my existing eyebrows.*
Yes I am aware, agree and acknowledge.
No
I hereby agree that I will not make any oral or written statement about my artist provider, her business, or staff, which is intended or reasonably likely to disparage her, her business, or any of her staff members, or that degrades her, its, their, reputation(s) in any way. This includes, but is not limited to, any disparaging oral or written statements posted on social media platforms.*
Yes I am aware, agree, and acknowledge.
No
I consent or waive the patch test. If waived, I release the technician from liability if I develop an allergic reaction to the pigments or products. A Patch test is where we take a small amount of the products we would use for the permanent makeup procedure and dot a few spots behind your ear, in your hair line. -I understand that allergic reactions such as stinging or burning sensations on the treating area or surrounding area, including the eyes, may occur. -I understand that an allergic reaction can occur at any time, even if I have received this service on previous occasions. -I understand that if I develop any allergic reaction, I must rinse with cold water, avoid using perfume or makeup products on the area, and should seek immediate medical attention. - I understand that a negative patch test does not guarantee that I will not have an adverse reaction to services performed.*
I would like a patch test prior to my appointment and understand this must be done 48 hours prior to my appointment and will reach out to Katie about doing the patch test.
I do not want a patch test.
I am over the age of 18*
No
Yes
I have not gotten botox in or around my face or head in 2 weeks and am aware that if I am dishonest about this that it can alter my microblading/powder brow results/shape. I agree I will not get Botox for at least 2 weeks prior to my appointment.*
No, I have to get Botox 2 weeks prior and am aware this will mean the cancelation of my PMU appointment.
Yes I am aware, agree and acknowledge that I cannot and will not get botox 2 weeks prior to my appointment.
The client fully, and voluntarily, consents to have the Specialist perform the permanent cosmetic procedure(s), and is fully aware and informed of all and any inherent risks, dangers, and complications associated with having permanent cosmetic facial tattoo procedures performed. The client has had any questions or concerns which he/she has expressed satisfactorily answered or resolved by the Specialist.*
Yes I am aware, agree and acknowledge.
No
The Client, realizing that cosmetic procedures of the type of those specified in this agreement are fraught with risks and dangers which cannot be eliminated from the process regardless of the precautions and safeguards which are undertaken, hereby agrees that the client releases the Specialist from any and all claims, damages, and liability of all types relating to the performance of the specified procedure(s), including any costs of medical care or assistance required by the Client as a result of the procedure(s) performed, which shall include any post-operative care, repair or reconstruction which the Client may require or desire. This release agreement by the client shall also extend to the proprietors, officers, agents, and employees of any business Specialist that is employed by or associated with performing the cosmetic procedure(s)*
Yes I am aware, agree and acknowledge.
No
I acknowledge it is not reasonably possible for the representatives and employees of this permanent makeup salon to determine whether I might have an allergic reaction to the pigments or processes used in my procedure, and I agree to accept the risk that such a reaction is possible. I am aware I will not receive ANY refunds for any allergic reaction to the PMU procedure.*
Yes I am aware, agree and acknowledge
No
I acknowledge that infection is always possible as a result of the obtaining of a permanent makeup, particularly in the event that I do not take proper care of my permanent makeup. I have received aftercare instructions and I agree to follow them carefully while my permanent makeup is healing. I agree that any touch-up work needed outside of the normal 6 week touch up, due to my own negligence, will be done at my own expense. I understand that if I do not follow the aftercare instructions carefully at my own negligence, my results may not be what was expected and I will not hold my artist responsible for such actions that were done by me.*
Yes I am aware, agree and acknowledge
No
I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my permanent makeup .*
Yes I am aware, agree and acknowledge
No
I understand that it is necessary for me to let my brow hair grow out as much as possible and I agree that I will not pluck, thread, wax, or remove any hair at least 2 weeks prior to my appointment. This is necessary to getting the proper shape for your brow and to avoid applying too much strokes/shading in areas that do naturally grow hair. I understand and am aware that if I do not follow this advice I may have less than satisfied results and will not blame my artist.*
Yes I am aware, agree and acknowledge.
No
I agree to release and forever discharge and hold harmless the Artist and all employees from any and all claims, damages or legal actions arising from or connected in any way with my permanent makeup , or the procedure and conduct used in my permanent makeup .*
Yes I am aware, agree and acknowledge.
No
I am aware that I cannot get the procedure done if I have been to the tanning bed/ or had natural sun at least two weeks or less prior to my appointment or if I have self tanner on my face at the appointment. Some tan is fine but we want to see your natural skin tone as much as possible so please do not lay out, go to the tanning bed, or self tan/spray tan for at least 2 weeks prior to your permanent makeup appointment.*
Yes I am aware, agree and acknowledge
No
I am aware that I cannot take any blood thinning medications such as Aspirin, Ibuprofen, Alcohol, Coumadin ect, at least 48 hours prior to my appointment. I am aware that by doing so this can affect the shape and healed results if too much blood is covering the pre-dran shade during the procedure. This could even result in the artist being forced to stop the procedure and reschedule your appointment. In a rare case as this, the cancelation fee would apply for the current appointment and a new full charge appointment will be necessary to complete the service.*
Yes I am aware, agree and acknowledge
No
I understand that it is my responsibility to ask questions about any information contained herein that I do not understand or is confusing to me and that I must do so prior to submitting this form. I understand that my submission of this form represents that I did not have any questions and that I fully understand all content. If I arrive to my appointment with anything that would prohibit my artist to proceed with the procedure, I hereby agree to pay a cancellation fee amounting to 35% of the services I booked which is due to my artist prior to leaving the scheduled appointment. If this should happen, I understand that I will need to reschedule my appointment for a later date and take any action necessary prior to me rescheduling my appointment.*
No
Yes I am aware, agree and acknowledge
Clients Medical History/misc. PLEASE ONLY CLICK THE BOXES IF YOU ARE ANSWERING YES TO THE QUESTION. by not clicking the boxes you are answering no.
Do you have a history of MRSA?
Have you/ will you have had Botox 2 weeks or sooner to your appointment?
Do you have diabetes?
Do you have hepatitis A B C D?
Have you had a brow lift or facelift?
Do you typically bleed easily?
Are you/ will you be under the influence of alcohol or drugs during your appointment?
Do you have any abnormal heart conditions?
Do you take medication before dental work?
Have you/will you have had a chemical peel within two weeks from your PMU appointment?
Are you pregnant or breatfeeding?
Have you had any brow or lash tinting?
Do you have an autoimmune disorder?
Are you currently being treated for cancer or been treated for it in the last 12 months?
Are you currently taking Accutane or acne treatments?
Are you under treatment of chemotherapy or radiation?
Do you have any tumors or cysts?
Have you/ will you have taken any blood thinning medications such as; Aspirin, Ibuprofen, Alcohol, Coumadin etc 48 hour or less than before your appointment?
Have you ever had any Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylene Glycol, Vitamin E Acetate, etc?
Do you use skin care products containing Retin-A, Glycolic Acid, or Alpha Hydroxyl? Please do not use these 48 hours prior to your appointment to avoid sensitivity.
Do you have any heart conditions?
Do you have a mitral or prolapsed heart valve
Do you have any joint replacements?
Do you have any type of blood diseases?
Are you hemophiliac?
Are you epileptic or subject to seizures?
Do you have glaucoma?
Do you have any dermatological disorders (eczema, rosacea, psoriasis, dermatitis, shingles, etc.)
Do you have herpes?
Do you have (or are you prone to) keloid formation?
Do you have trichotillomania?
Do you have alopecia?
Do you use steroids?
Do you have Tourette's syndrome or are you prone to nervous ticks?
Are you planning to have any cosmetic or other surgeries for at least 3 months after your appointment?
Do you have other tattoos?
I agree that I have answered all of the above questions truthfully and to the best of my knowledge. I understand that if I did not, anything can pose a risk to my permanent makeup procedure and could alter my results, resulting in infection or other possible risks. I understand that if I did not, and come to my appointment with anything that would prohibit my artist to proceed with the procedure that a cancellation fee of 35% of the service booked will be due before leaving the appointment and I will need to reschedule to a later date and/or take any action necessary before rescheduling, based on the case.*
Yes I am aware, agree and acknowledge.
No
Post Procedure Care for PMU Procedure. Results vary based on the "canvas" (your skin) that they are performed on. Lifestyle, medications, smoking, metabolism, facial surgery and other procedures, and age of skin all contribute to fading, color change over time. In some cases PMU can turn red, blue, or other colors depending on your skin and how it heals. There are color correctors that can fix the discoloration over time. I understand that I accept such risks. Though rare, infection is possible. If you see signs of infection such as persistent increased redness or swelling, fever, drainage, or oozing, contact your doctor immediately. When the area starts to flake, leave it. Do not pick, peel or pull on the skin whatsoever. Let the scabs or flakes come off naturally on its own.• Wash area lightly with mild foamy soap and finger tips every 3 hours, 2-3 times for the first day directly after the procedure, pat dry well, then apply a very thin layer of aftercare ointment (provided to you by your technician) to the area as advised. Day 2, wash the area lightly only morning and night, pat dry well, then apply a very thin layer or healing ointment. Day 3 STOP THE CLEANING, and only use the healing ointment morning, afternoon, and night as needed. If you apply it in the morning and by the afternoon there is still ointment on there, there is no need to reapply it. Over applying the healing ointment or putting too much on can cause your results to blur or heal correctly. It's very important to only apply a very very thin layer of ointment when using the healing ointment. Continue applying the healing ointment (morning, afternoon and night as needed) from day 4 and on for about 3 weeks or until healed. You should have enough healing ointment for your healing process after the first appointment AND for your healing process after the 6 week touch up which will be the same healing process/aftercare instructions. This will help you realize how little ointment you need to use and to not over apply. • Avoid sweating such as from vigorous exercise for 3 weeks. For at least 2/3 weeks post-procedure or until healing is complete: Keep your hands clean and avoid touching the affected area(s). Do not scrub or pick treated areas, Do not use peroxide or Neosporin on treated areas, Do not expose area to direct sun or to tanning beds, Avoid exposing the area to excessive moisture or humidity, such as: facials, swimming, whirlpools (hot tubs), saunas, steam rooms, and steamy showers. • Avoid Retin-A, moisturizers, glycolic acids, exfoliants and anti-aging products at all times (not just during healing) on all microbladed/shaded areas. These can cause pigments to fade and lighten prematurely. • Avoid tanning beds, sun, chlorine spas and pools, soap and chemicals (including skin cleansers, makeupremovers, alpha hydroxyl creams, and tooth whitening toothpaste) near the treated area until healed. • Pigments will slowly fade overtime according to one's metabolism, skin type, sun exposure, medication, facial surgery, and smoking. Schedule maintenance visits as needed to keep it looking fresh (no sooner than 12-18 months from your original appointment). • Periodic colorboosts will ensure longer lasting results however getting a colorboost too soon is unnecessary. If you're unsure if you're ready for a colorboost please contact me directly and send photos of your current brows. • Do not resume any method of eyebrow hair removal or coloration for at least 3 weeks. • Avoid eyebrow tinting within two weeks before or after the procedure. Do not apply any makeup, self tanners, spray tan, sunscreen or any other facial products, ect on or around your brows for at least 3-4 weeks until healed. Do not get them wet or sweat on them for at least 3-4 weeks until healed. I agree that I have been made aware of the aftercare instructions and have read through thoroughly. I am aware that by not following the aftercare instructions carefully, that it can alter my healed results due to my own negligence. You will also be given these instructions verbally at your appointment and can ask any questions at the appointment about the aftercare. I agree I have read and agree to follow these instructions carefully.*
Yes I have read and understand/agree with the above information.
No
Microblading/powder brow Healing scheduleOne of the most common questions we're asked is what to expect during the healing process. While every person is different and some heal more quickly or slowly than others, here's generally what to expect. Temporary side effects from micropigmentation include but are not limited to: redness, swelling, puffiness, bruising, dry patches and tenderness. You should expect to lose approximately 1/3 of the initial color during the healing process. We have selected the optimal pigments for you with this in mind. The first couple of days they may get extremely dark. In approximately six days or more it may appear too light. After about 10 days, the color will show more. It will appear softer when completely healed. Day 1 The eyebrows are approximately 20- 25% bolder and darker in width than they will be when healed. Expect light to moderate swelling and redness. The skin's redness causes the color of the pigment to appear darker. There is some swelling, although difficult to actually see due to the thickness of the skin in the eyebrow area. This will subside. New skin will heal over the pigmented area and result in a softer appearance of your eyebrows. Don't be concerned that your eyebrows initially appear darker and heavier in size than you desire. This is all part of the process. Eyebrows may start to itch. The skin begins to flake, peeling from the outside edges first. Color finishes flaking off and appears softer and grayer for a few days until color clarifies. The color has lightened from its initial overly-dark appearance. For the next few days, the color may now be lighter than what the final color will be. The final color begins to stabilize and show through. The color will continue to soften as the healing process completes. I UNDERSTAND AND ACCEPT THAT FAILURE TO FOLLOW THE POST-PROCEDURE INSTRUCTIONS ABOVE MAY RESULT IN A LOSS OR DISCOLORATION OF PIGMENT RESULTING IN A NEED FOR MORE FREQUENT TOUCHUPS OR LESS THAN DESIRED RESULTS. I agree I have read through this carefully.*
Yes I am aware, agree, acknowledge and understand the above information.
No
The Client acknowledges receipt of pre-procedure information and post-procedure (aftercare) instructions from the Specialist, and agrees that they have read them, have been advised of them, understand them, and agree to adhere to them in order to help ensure satisfactory results from the procedure(s) and help prevent secondary infection. The Client acknowledges that all final adjustments and detail work will be done in the second session, and will schedule a follow-up session with the Specialist 6 weeks of the procedure(s).*
Yes I am aware, agree and acknowledge
No

By signing below this line, I acknowledge that I have thoroughly read the entirety of this form, that I understand the terms contained herein, that I agree to adhere to any and all pre and post procedure directions, and that my answers were accurate and honest.
Fourth Client's Name

First Name*

Middle Name

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

Date of Scheduled Appointment *

Email Address *
Check list of things NOT to do/take at least 48 hours to 2 weeks prior to your appointment. *
By checking the boxes below next to each statement, I confirm that I have read and fully understand each item/statement made and that I am solely and personally responsible for avoiding or undertaking the following actions to ensure my own safety.
I understand I cannot drink alcohol or caffeine at least 24 hours before appointment.
I understand I cannot take ibuprofen, aspirin, fish oil or any other medications that will thin my blood at least 48 hours before my appointment.
I understand I should not take or self tan at least 2 weeks prior to my appointment. If self tanning please avoid the face area as we want to see your natural skin tone as much as possible.
I understand I need to come to my appointment with no makeup on
I understand I should not wax, tweeze, thread or remove any brow hair for at least 2 weeks before your appointment. We will need to see where all of your hair growth is.
I understand I cannot get botox for at least 2 weeks prior to my appointment.
I am aware of, and I agree to the following: The Microblading, or Powder Brows procedure, is a type of cosmetic tattooing. Usually, the healing period lasts between 2-4 weeks. A second visit is usually required thereafter at about 6 weeks. In some cases, more visits may be needed. During the healing period, redness, swelling, scabbing of the kind, irritation, itching, minor bleeding, and other effects may occur. I am aware that the final result will be achieved anywhere from 6-8 weeks following my last visit. *
Yes, I am aware, agree and acknowledge.
No
I am aware that the results of this desired cosmetic procedure can be affected by the following items or actions, including, but not limited to, medications, skin type, smoking, drug and alcohol use, the use of cosmetic skin care products and makeup on the eyebrow area, activities causing sweating or perspiration, eyebrow plucking, cosmetic surgery, and use of cosmetic injections. Further, I understand that if I am on any medications that I believe may impact the results of this cosmetic procedure, that it is my responsibility to consult a doctor prior to proceeding with any procedure *
Yes I am aware, agree and acknowledge.
No
I am aware that the results can be affected by: medication, skin type, smoking, drug and alcohol use, use of cosmetic skin care products and makeup on the eyebrow area, activities causing sweating, eyebrow plucking, cosmetic surgery, use of cosmetic injections and many other factors.*
Yes I am aware, agree and acknowledge.
No
I am aware that the pigments after initial procedure may partially and/or fully fade and/or disappear and full success cannot be guaranteed which is why the second visit (touch up) is highly recommended. I am aware that if I do not complete the process by scheduling and coming to the 6 week touch up, my results may not last the 1-3 years or longer that I was originally made aware of. I am aware that by not completing the touch up my results may only last (but not limited to) up to 6 months or less.*
Yes I am aware, agree and acknowledge.
No
I acknowledge that the final color and shade will be achieved after 6-8 weeks after the touch up and the pigment colors and shade may vary with time.*
Yes, I am aware, agree and acknowledge.
No
I understand that in some cases, numbing topical cream may be necessary. I further understand that it may cause some level of sensitivity, discomfort, allergic reaction, redness, swelling or other reactions, depending on the skin type and sensitivity*
Yes, I am aware, agree and acknowledge
No
I am aware of the risks of possible allergic reactions, infections and any other complications as a result of the procedure, especially if I do not take care of the eyebrows or follow proper aftercare instructions, and the skin in that area. In extremely rare cases some scarring is possible. I accept such risks and accept full responsibility for any post treatment complication. I informed the practitioner of my known allergies.*
Yes I am aware, agree and acknowledge
No
I acknowledge that the correcting and the revision of any type of existing permanent makeup, tattoo etc, previously performed by other providers involves additional risks due to unknown factors, such as but not limited to, brand, color, time, skin reaction, depth and others and the practitioner has no full control over the potential results and I accept full responsibility for the final outcome and complications.*
Yes I am aware, agree and acknowledge
No
I understand the following medical conditions require consent from the doctor:Diabetes, HIV, hepatitis, high blood pressure, thyroid disease, herpes, have a history of MRSA or staph infection, have any type of abnormal heart conditions, any type of autoimmune disorders, have any type of blood diseases, have glaucoma, have trichotillomania, alopecia, hemophilia, leukemia, anemia and any other blood disorders, any type of cancer, nursing and any type of liver disorders, have had any type of surgeries in the past 12 months, or under a doctors care for any particular condition. I will not hold Katie Riddle ( beautybykatiellc) liable if I choose not to get consent from my doctor. I am aware I cannot get microblading/powder brows if I am pregnant.*
I am aware/agree and acknowledge and do NOT have any of these conditions that I need to get consent from my doctors approval for.
I will need to get consent from my doctor for one or more of these conditions and will let my artist know upon approval/ disapproval as soon as possible before my appointment to avoid last minute cancellations due to the possibility of non approval from my doctor. I am aware that any last minute cancellations due to disapproval is still subject to cancellation fees within 48 hours.
I am aware that I will have the opportunity to approve the shape created by my artist provider before doing anything permanent therefore if I am unhappy with the shape, I am fully aware that I approved it before beginning. I give my consent to use Permanent Makeup tools/machine to apply pigments into my skin in the eyebrow area and modify the look of my existing eyebrows.*
Yes I am aware, agree and acknowledge.
No
I hereby agree that I will not make any oral or written statement about my artist provider, her business, or staff, which is intended or reasonably likely to disparage her, her business, or any of her staff members, or that degrades her, its, their, reputation(s) in any way. This includes, but is not limited to, any disparaging oral or written statements posted on social media platforms.*
Yes I am aware, agree, and acknowledge.
No
I consent or waive the patch test. If waived, I release the technician from liability if I develop an allergic reaction to the pigments or products. A Patch test is where we take a small amount of the products we would use for the permanent makeup procedure and dot a few spots behind your ear, in your hair line. -I understand that allergic reactions such as stinging or burning sensations on the treating area or surrounding area, including the eyes, may occur. -I understand that an allergic reaction can occur at any time, even if I have received this service on previous occasions. -I understand that if I develop any allergic reaction, I must rinse with cold water, avoid using perfume or makeup products on the area, and should seek immediate medical attention. - I understand that a negative patch test does not guarantee that I will not have an adverse reaction to services performed.*
I would like a patch test prior to my appointment and understand this must be done 48 hours prior to my appointment and will reach out to Katie about doing the patch test.
I do not want a patch test.
I am over the age of 18*
No
Yes
I have not gotten botox in or around my face or head in 2 weeks and am aware that if I am dishonest about this that it can alter my microblading/powder brow results/shape. I agree I will not get Botox for at least 2 weeks prior to my appointment.*
No, I have to get Botox 2 weeks prior and am aware this will mean the cancelation of my PMU appointment.
Yes I am aware, agree and acknowledge that I cannot and will not get botox 2 weeks prior to my appointment.
The client fully, and voluntarily, consents to have the Specialist perform the permanent cosmetic procedure(s), and is fully aware and informed of all and any inherent risks, dangers, and complications associated with having permanent cosmetic facial tattoo procedures performed. The client has had any questions or concerns which he/she has expressed satisfactorily answered or resolved by the Specialist.*
Yes I am aware, agree and acknowledge.
No
The Client, realizing that cosmetic procedures of the type of those specified in this agreement are fraught with risks and dangers which cannot be eliminated from the process regardless of the precautions and safeguards which are undertaken, hereby agrees that the client releases the Specialist from any and all claims, damages, and liability of all types relating to the performance of the specified procedure(s), including any costs of medical care or assistance required by the Client as a result of the procedure(s) performed, which shall include any post-operative care, repair or reconstruction which the Client may require or desire. This release agreement by the client shall also extend to the proprietors, officers, agents, and employees of any business Specialist that is employed by or associated with performing the cosmetic procedure(s)*
Yes I am aware, agree and acknowledge.
No
I acknowledge it is not reasonably possible for the representatives and employees of this permanent makeup salon to determine whether I might have an allergic reaction to the pigments or processes used in my procedure, and I agree to accept the risk that such a reaction is possible. I am aware I will not receive ANY refunds for any allergic reaction to the PMU procedure.*
Yes I am aware, agree and acknowledge
No
I acknowledge that infection is always possible as a result of the obtaining of a permanent makeup, particularly in the event that I do not take proper care of my permanent makeup. I have received aftercare instructions and I agree to follow them carefully while my permanent makeup is healing. I agree that any touch-up work needed outside of the normal 6 week touch up, due to my own negligence, will be done at my own expense. I understand that if I do not follow the aftercare instructions carefully at my own negligence, my results may not be what was expected and I will not hold my artist responsible for such actions that were done by me.*
Yes I am aware, agree and acknowledge
No
I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my permanent makeup .*
Yes I am aware, agree and acknowledge
No
I understand that it is necessary for me to let my brow hair grow out as much as possible and I agree that I will not pluck, thread, wax, or remove any hair at least 2 weeks prior to my appointment. This is necessary to getting the proper shape for your brow and to avoid applying too much strokes/shading in areas that do naturally grow hair. I understand and am aware that if I do not follow this advice I may have less than satisfied results and will not blame my artist.*
Yes I am aware, agree and acknowledge.
No
I agree to release and forever discharge and hold harmless the Artist and all employees from any and all claims, damages or legal actions arising from or connected in any way with my permanent makeup , or the procedure and conduct used in my permanent makeup .*
Yes I am aware, agree and acknowledge.
No
I am aware that I cannot get the procedure done if I have been to the tanning bed/ or had natural sun at least two weeks or less prior to my appointment or if I have self tanner on my face at the appointment. Some tan is fine but we want to see your natural skin tone as much as possible so please do not lay out, go to the tanning bed, or self tan/spray tan for at least 2 weeks prior to your permanent makeup appointment.*
Yes I am aware, agree and acknowledge
No
I am aware that I cannot take any blood thinning medications such as Aspirin, Ibuprofen, Alcohol, Coumadin ect, at least 48 hours prior to my appointment. I am aware that by doing so this can affect the shape and healed results if too much blood is covering the pre-dran shade during the procedure. This could even result in the artist being forced to stop the procedure and reschedule your appointment. In a rare case as this, the cancelation fee would apply for the current appointment and a new full charge appointment will be necessary to complete the service.*
Yes I am aware, agree and acknowledge
No
I understand that it is my responsibility to ask questions about any information contained herein that I do not understand or is confusing to me and that I must do so prior to submitting this form. I understand that my submission of this form represents that I did not have any questions and that I fully understand all content. If I arrive to my appointment with anything that would prohibit my artist to proceed with the procedure, I hereby agree to pay a cancellation fee amounting to 35% of the services I booked which is due to my artist prior to leaving the scheduled appointment. If this should happen, I understand that I will need to reschedule my appointment for a later date and take any action necessary prior to me rescheduling my appointment.*
No
Yes I am aware, agree and acknowledge
Clients Medical History/misc. PLEASE ONLY CLICK THE BOXES IF YOU ARE ANSWERING YES TO THE QUESTION. by not clicking the boxes you are answering no.
Do you have a history of MRSA?
Have you/ will you have had Botox 2 weeks or sooner to your appointment?
Do you have diabetes?
Do you have hepatitis A B C D?
Have you had a brow lift or facelift?
Do you typically bleed easily?
Are you/ will you be under the influence of alcohol or drugs during your appointment?
Do you have any abnormal heart conditions?
Do you take medication before dental work?
Have you/will you have had a chemical peel within two weeks from your PMU appointment?
Are you pregnant or breatfeeding?
Have you had any brow or lash tinting?
Do you have an autoimmune disorder?
Are you currently being treated for cancer or been treated for it in the last 12 months?
Are you currently taking Accutane or acne treatments?
Are you under treatment of chemotherapy or radiation?
Do you have any tumors or cysts?
Have you/ will you have taken any blood thinning medications such as; Aspirin, Ibuprofen, Alcohol, Coumadin etc 48 hour or less than before your appointment?
Have you ever had any Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylene Glycol, Vitamin E Acetate, etc?
Do you use skin care products containing Retin-A, Glycolic Acid, or Alpha Hydroxyl? Please do not use these 48 hours prior to your appointment to avoid sensitivity.
Do you have any heart conditions?
Do you have a mitral or prolapsed heart valve
Do you have any joint replacements?
Do you have any type of blood diseases?
Are you hemophiliac?
Are you epileptic or subject to seizures?
Do you have glaucoma?
Do you have any dermatological disorders (eczema, rosacea, psoriasis, dermatitis, shingles, etc.)
Do you have herpes?
Do you have (or are you prone to) keloid formation?
Do you have trichotillomania?
Do you have alopecia?
Do you use steroids?
Do you have Tourette's syndrome or are you prone to nervous ticks?
Are you planning to have any cosmetic or other surgeries for at least 3 months after your appointment?
Do you have other tattoos?
I agree that I have answered all of the above questions truthfully and to the best of my knowledge. I understand that if I did not, anything can pose a risk to my permanent makeup procedure and could alter my results, resulting in infection or other possible risks. I understand that if I did not, and come to my appointment with anything that would prohibit my artist to proceed with the procedure that a cancellation fee of 35% of the service booked will be due before leaving the appointment and I will need to reschedule to a later date and/or take any action necessary before rescheduling, based on the case.*
Yes I am aware, agree and acknowledge.
No
Post Procedure Care for PMU Procedure. Results vary based on the "canvas" (your skin) that they are performed on. Lifestyle, medications, smoking, metabolism, facial surgery and other procedures, and age of skin all contribute to fading, color change over time. In some cases PMU can turn red, blue, or other colors depending on your skin and how it heals. There are color correctors that can fix the discoloration over time. I understand that I accept such risks. Though rare, infection is possible. If you see signs of infection such as persistent increased redness or swelling, fever, drainage, or oozing, contact your doctor immediately. When the area starts to flake, leave it. Do not pick, peel or pull on the skin whatsoever. Let the scabs or flakes come off naturally on its own.• Wash area lightly with mild foamy soap and finger tips every 3 hours, 2-3 times for the first day directly after the procedure, pat dry well, then apply a very thin layer of aftercare ointment (provided to you by your technician) to the area as advised. Day 2, wash the area lightly only morning and night, pat dry well, then apply a very thin layer or healing ointment. Day 3 STOP THE CLEANING, and only use the healing ointment morning, afternoon, and night as needed. If you apply it in the morning and by the afternoon there is still ointment on there, there is no need to reapply it. Over applying the healing ointment or putting too much on can cause your results to blur or heal correctly. It's very important to only apply a very very thin layer of ointment when using the healing ointment. Continue applying the healing ointment (morning, afternoon and night as needed) from day 4 and on for about 3 weeks or until healed. You should have enough healing ointment for your healing process after the first appointment AND for your healing process after the 6 week touch up which will be the same healing process/aftercare instructions. This will help you realize how little ointment you need to use and to not over apply. • Avoid sweating such as from vigorous exercise for 3 weeks. For at least 2/3 weeks post-procedure or until healing is complete: Keep your hands clean and avoid touching the affected area(s). Do not scrub or pick treated areas, Do not use peroxide or Neosporin on treated areas, Do not expose area to direct sun or to tanning beds, Avoid exposing the area to excessive moisture or humidity, such as: facials, swimming, whirlpools (hot tubs), saunas, steam rooms, and steamy showers. • Avoid Retin-A, moisturizers, glycolic acids, exfoliants and anti-aging products at all times (not just during healing) on all microbladed/shaded areas. These can cause pigments to fade and lighten prematurely. • Avoid tanning beds, sun, chlorine spas and pools, soap and chemicals (including skin cleansers, makeupremovers, alpha hydroxyl creams, and tooth whitening toothpaste) near the treated area until healed. • Pigments will slowly fade overtime according to one's metabolism, skin type, sun exposure, medication, facial surgery, and smoking. Schedule maintenance visits as needed to keep it looking fresh (no sooner than 12-18 months from your original appointment). • Periodic colorboosts will ensure longer lasting results however getting a colorboost too soon is unnecessary. If you're unsure if you're ready for a colorboost please contact me directly and send photos of your current brows. • Do not resume any method of eyebrow hair removal or coloration for at least 3 weeks. • Avoid eyebrow tinting within two weeks before or after the procedure. Do not apply any makeup, self tanners, spray tan, sunscreen or any other facial products, ect on or around your brows for at least 3-4 weeks until healed. Do not get them wet or sweat on them for at least 3-4 weeks until healed. I agree that I have been made aware of the aftercare instructions and have read through thoroughly. I am aware that by not following the aftercare instructions carefully, that it can alter my healed results due to my own negligence. You will also be given these instructions verbally at your appointment and can ask any questions at the appointment about the aftercare. I agree I have read and agree to follow these instructions carefully.*
Yes I have read and understand/agree with the above information.
No
Microblading/powder brow Healing scheduleOne of the most common questions we're asked is what to expect during the healing process. While every person is different and some heal more quickly or slowly than others, here's generally what to expect. Temporary side effects from micropigmentation include but are not limited to: redness, swelling, puffiness, bruising, dry patches and tenderness. You should expect to lose approximately 1/3 of the initial color during the healing process. We have selected the optimal pigments for you with this in mind. The first couple of days they may get extremely dark. In approximately six days or more it may appear too light. After about 10 days, the color will show more. It will appear softer when completely healed. Day 1 The eyebrows are approximately 20- 25% bolder and darker in width than they will be when healed. Expect light to moderate swelling and redness. The skin's redness causes the color of the pigment to appear darker. There is some swelling, although difficult to actually see due to the thickness of the skin in the eyebrow area. This will subside. New skin will heal over the pigmented area and result in a softer appearance of your eyebrows. Don't be concerned that your eyebrows initially appear darker and heavier in size than you desire. This is all part of the process. Eyebrows may start to itch. The skin begins to flake, peeling from the outside edges first. Color finishes flaking off and appears softer and grayer for a few days until color clarifies. The color has lightened from its initial overly-dark appearance. For the next few days, the color may now be lighter than what the final color will be. The final color begins to stabilize and show through. The color will continue to soften as the healing process completes. I UNDERSTAND AND ACCEPT THAT FAILURE TO FOLLOW THE POST-PROCEDURE INSTRUCTIONS ABOVE MAY RESULT IN A LOSS OR DISCOLORATION OF PIGMENT RESULTING IN A NEED FOR MORE FREQUENT TOUCHUPS OR LESS THAN DESIRED RESULTS. I agree I have read through this carefully.*
Yes I am aware, agree, acknowledge and understand the above information.
No
The Client acknowledges receipt of pre-procedure information and post-procedure (aftercare) instructions from the Specialist, and agrees that they have read them, have been advised of them, understand them, and agree to adhere to them in order to help ensure satisfactory results from the procedure(s) and help prevent secondary infection. The Client acknowledges that all final adjustments and detail work will be done in the second session, and will schedule a follow-up session with the Specialist 6 weeks of the procedure(s).*
Yes I am aware, agree and acknowledge
No

By signing below this line, I acknowledge that I have thoroughly read the entirety of this form, that I understand the terms contained herein, that I agree to adhere to any and all pre and post procedure directions, and that my answers were accurate and honest.
Fifth Client's Name

First Name*

Middle Name

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

Date of Scheduled Appointment *

Email Address *
Check list of things NOT to do/take at least 48 hours to 2 weeks prior to your appointment. *
By checking the boxes below next to each statement, I confirm that I have read and fully understand each item/statement made and that I am solely and personally responsible for avoiding or undertaking the following actions to ensure my own safety.
I understand I cannot drink alcohol or caffeine at least 24 hours before appointment.
I understand I cannot take ibuprofen, aspirin, fish oil or any other medications that will thin my blood at least 48 hours before my appointment.
I understand I should not take or self tan at least 2 weeks prior to my appointment. If self tanning please avoid the face area as we want to see your natural skin tone as much as possible.
I understand I need to come to my appointment with no makeup on
I understand I should not wax, tweeze, thread or remove any brow hair for at least 2 weeks before your appointment. We will need to see where all of your hair growth is.
I understand I cannot get botox for at least 2 weeks prior to my appointment.
I am aware of, and I agree to the following: The Microblading, or Powder Brows procedure, is a type of cosmetic tattooing. Usually, the healing period lasts between 2-4 weeks. A second visit is usually required thereafter at about 6 weeks. In some cases, more visits may be needed. During the healing period, redness, swelling, scabbing of the kind, irritation, itching, minor bleeding, and other effects may occur. I am aware that the final result will be achieved anywhere from 6-8 weeks following my last visit. *
Yes, I am aware, agree and acknowledge.
No
I am aware that the results of this desired cosmetic procedure can be affected by the following items or actions, including, but not limited to, medications, skin type, smoking, drug and alcohol use, the use of cosmetic skin care products and makeup on the eyebrow area, activities causing sweating or perspiration, eyebrow plucking, cosmetic surgery, and use of cosmetic injections. Further, I understand that if I am on any medications that I believe may impact the results of this cosmetic procedure, that it is my responsibility to consult a doctor prior to proceeding with any procedure *
Yes I am aware, agree and acknowledge.
No
I am aware that the results can be affected by: medication, skin type, smoking, drug and alcohol use, use of cosmetic skin care products and makeup on the eyebrow area, activities causing sweating, eyebrow plucking, cosmetic surgery, use of cosmetic injections and many other factors.*
Yes I am aware, agree and acknowledge.
No
I am aware that the pigments after initial procedure may partially and/or fully fade and/or disappear and full success cannot be guaranteed which is why the second visit (touch up) is highly recommended. I am aware that if I do not complete the process by scheduling and coming to the 6 week touch up, my results may not last the 1-3 years or longer that I was originally made aware of. I am aware that by not completing the touch up my results may only last (but not limited to) up to 6 months or less.*
Yes I am aware, agree and acknowledge.
No
I acknowledge that the final color and shade will be achieved after 6-8 weeks after the touch up and the pigment colors and shade may vary with time.*
Yes, I am aware, agree and acknowledge.
No
I understand that in some cases, numbing topical cream may be necessary. I further understand that it may cause some level of sensitivity, discomfort, allergic reaction, redness, swelling or other reactions, depending on the skin type and sensitivity*
Yes, I am aware, agree and acknowledge
No
I am aware of the risks of possible allergic reactions, infections and any other complications as a result of the procedure, especially if I do not take care of the eyebrows or follow proper aftercare instructions, and the skin in that area. In extremely rare cases some scarring is possible. I accept such risks and accept full responsibility for any post treatment complication. I informed the practitioner of my known allergies.*
Yes I am aware, agree and acknowledge
No
I acknowledge that the correcting and the revision of any type of existing permanent makeup, tattoo etc, previously performed by other providers involves additional risks due to unknown factors, such as but not limited to, brand, color, time, skin reaction, depth and others and the practitioner has no full control over the potential results and I accept full responsibility for the final outcome and complications.*
Yes I am aware, agree and acknowledge
No
I understand the following medical conditions require consent from the doctor:Diabetes, HIV, hepatitis, high blood pressure, thyroid disease, herpes, have a history of MRSA or staph infection, have any type of abnormal heart conditions, any type of autoimmune disorders, have any type of blood diseases, have glaucoma, have trichotillomania, alopecia, hemophilia, leukemia, anemia and any other blood disorders, any type of cancer, nursing and any type of liver disorders, have had any type of surgeries in the past 12 months, or under a doctors care for any particular condition. I will not hold Katie Riddle ( beautybykatiellc) liable if I choose not to get consent from my doctor. I am aware I cannot get microblading/powder brows if I am pregnant.*
I am aware/agree and acknowledge and do NOT have any of these conditions that I need to get consent from my doctors approval for.
I will need to get consent from my doctor for one or more of these conditions and will let my artist know upon approval/ disapproval as soon as possible before my appointment to avoid last minute cancellations due to the possibility of non approval from my doctor. I am aware that any last minute cancellations due to disapproval is still subject to cancellation fees within 48 hours.
I am aware that I will have the opportunity to approve the shape created by my artist provider before doing anything permanent therefore if I am unhappy with the shape, I am fully aware that I approved it before beginning. I give my consent to use Permanent Makeup tools/machine to apply pigments into my skin in the eyebrow area and modify the look of my existing eyebrows.*
Yes I am aware, agree and acknowledge.
No
I hereby agree that I will not make any oral or written statement about my artist provider, her business, or staff, which is intended or reasonably likely to disparage her, her business, or any of her staff members, or that degrades her, its, their, reputation(s) in any way. This includes, but is not limited to, any disparaging oral or written statements posted on social media platforms.*
Yes I am aware, agree, and acknowledge.
No
I consent or waive the patch test. If waived, I release the technician from liability if I develop an allergic reaction to the pigments or products. A Patch test is where we take a small amount of the products we would use for the permanent makeup procedure and dot a few spots behind your ear, in your hair line. -I understand that allergic reactions such as stinging or burning sensations on the treating area or surrounding area, including the eyes, may occur. -I understand that an allergic reaction can occur at any time, even if I have received this service on previous occasions. -I understand that if I develop any allergic reaction, I must rinse with cold water, avoid using perfume or makeup products on the area, and should seek immediate medical attention. - I understand that a negative patch test does not guarantee that I will not have an adverse reaction to services performed.*
I would like a patch test prior to my appointment and understand this must be done 48 hours prior to my appointment and will reach out to Katie about doing the patch test.
I do not want a patch test.
I am over the age of 18*
No
Yes
I have not gotten botox in or around my face or head in 2 weeks and am aware that if I am dishonest about this that it can alter my microblading/powder brow results/shape. I agree I will not get Botox for at least 2 weeks prior to my appointment.*
No, I have to get Botox 2 weeks prior and am aware this will mean the cancelation of my PMU appointment.
Yes I am aware, agree and acknowledge that I cannot and will not get botox 2 weeks prior to my appointment.
The client fully, and voluntarily, consents to have the Specialist perform the permanent cosmetic procedure(s), and is fully aware and informed of all and any inherent risks, dangers, and complications associated with having permanent cosmetic facial tattoo procedures performed. The client has had any questions or concerns which he/she has expressed satisfactorily answered or resolved by the Specialist.*
Yes I am aware, agree and acknowledge.
No
The Client, realizing that cosmetic procedures of the type of those specified in this agreement are fraught with risks and dangers which cannot be eliminated from the process regardless of the precautions and safeguards which are undertaken, hereby agrees that the client releases the Specialist from any and all claims, damages, and liability of all types relating to the performance of the specified procedure(s), including any costs of medical care or assistance required by the Client as a result of the procedure(s) performed, which shall include any post-operative care, repair or reconstruction which the Client may require or desire. This release agreement by the client shall also extend to the proprietors, officers, agents, and employees of any business Specialist that is employed by or associated with performing the cosmetic procedure(s)*
Yes I am aware, agree and acknowledge.
No
I acknowledge it is not reasonably possible for the representatives and employees of this permanent makeup salon to determine whether I might have an allergic reaction to the pigments or processes used in my procedure, and I agree to accept the risk that such a reaction is possible. I am aware I will not receive ANY refunds for any allergic reaction to the PMU procedure.*
Yes I am aware, agree and acknowledge
No
I acknowledge that infection is always possible as a result of the obtaining of a permanent makeup, particularly in the event that I do not take proper care of my permanent makeup. I have received aftercare instructions and I agree to follow them carefully while my permanent makeup is healing. I agree that any touch-up work needed outside of the normal 6 week touch up, due to my own negligence, will be done at my own expense. I understand that if I do not follow the aftercare instructions carefully at my own negligence, my results may not be what was expected and I will not hold my artist responsible for such actions that were done by me.*
Yes I am aware, agree and acknowledge
No
I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my permanent makeup .*
Yes I am aware, agree and acknowledge
No
I understand that it is necessary for me to let my brow hair grow out as much as possible and I agree that I will not pluck, thread, wax, or remove any hair at least 2 weeks prior to my appointment. This is necessary to getting the proper shape for your brow and to avoid applying too much strokes/shading in areas that do naturally grow hair. I understand and am aware that if I do not follow this advice I may have less than satisfied results and will not blame my artist.*
Yes I am aware, agree and acknowledge.
No
I agree to release and forever discharge and hold harmless the Artist and all employees from any and all claims, damages or legal actions arising from or connected in any way with my permanent makeup , or the procedure and conduct used in my permanent makeup .*
Yes I am aware, agree and acknowledge.
No
I am aware that I cannot get the procedure done if I have been to the tanning bed/ or had natural sun at least two weeks or less prior to my appointment or if I have self tanner on my face at the appointment. Some tan is fine but we want to see your natural skin tone as much as possible so please do not lay out, go to the tanning bed, or self tan/spray tan for at least 2 weeks prior to your permanent makeup appointment.*
Yes I am aware, agree and acknowledge
No
I am aware that I cannot take any blood thinning medications such as Aspirin, Ibuprofen, Alcohol, Coumadin ect, at least 48 hours prior to my appointment. I am aware that by doing so this can affect the shape and healed results if too much blood is covering the pre-dran shade during the procedure. This could even result in the artist being forced to stop the procedure and reschedule your appointment. In a rare case as this, the cancelation fee would apply for the current appointment and a new full charge appointment will be necessary to complete the service.*
Yes I am aware, agree and acknowledge
No
I understand that it is my responsibility to ask questions about any information contained herein that I do not understand or is confusing to me and that I must do so prior to submitting this form. I understand that my submission of this form represents that I did not have any questions and that I fully understand all content. If I arrive to my appointment with anything that would prohibit my artist to proceed with the procedure, I hereby agree to pay a cancellation fee amounting to 35% of the services I booked which is due to my artist prior to leaving the scheduled appointment. If this should happen, I understand that I will need to reschedule my appointment for a later date and take any action necessary prior to me rescheduling my appointment.*
No
Yes I am aware, agree and acknowledge
Clients Medical History/misc. PLEASE ONLY CLICK THE BOXES IF YOU ARE ANSWERING YES TO THE QUESTION. by not clicking the boxes you are answering no.
Do you have a history of MRSA?
Have you/ will you have had Botox 2 weeks or sooner to your appointment?
Do you have diabetes?
Do you have hepatitis A B C D?
Have you had a brow lift or facelift?
Do you typically bleed easily?
Are you/ will you be under the influence of alcohol or drugs during your appointment?
Do you have any abnormal heart conditions?
Do you take medication before dental work?
Have you/will you have had a chemical peel within two weeks from your PMU appointment?
Are you pregnant or breatfeeding?
Have you had any brow or lash tinting?
Do you have an autoimmune disorder?
Are you currently being treated for cancer or been treated for it in the last 12 months?
Are you currently taking Accutane or acne treatments?
Are you under treatment of chemotherapy or radiation?
Do you have any tumors or cysts?
Have you/ will you have taken any blood thinning medications such as; Aspirin, Ibuprofen, Alcohol, Coumadin etc 48 hour or less than before your appointment?
Have you ever had any Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylene Glycol, Vitamin E Acetate, etc?
Do you use skin care products containing Retin-A, Glycolic Acid, or Alpha Hydroxyl? Please do not use these 48 hours prior to your appointment to avoid sensitivity.
Do you have any heart conditions?
Do you have a mitral or prolapsed heart valve
Do you have any joint replacements?
Do you have any type of blood diseases?
Are you hemophiliac?
Are you epileptic or subject to seizures?
Do you have glaucoma?
Do you have any dermatological disorders (eczema, rosacea, psoriasis, dermatitis, shingles, etc.)
Do you have herpes?
Do you have (or are you prone to) keloid formation?
Do you have trichotillomania?
Do you have alopecia?
Do you use steroids?
Do you have Tourette's syndrome or are you prone to nervous ticks?
Are you planning to have any cosmetic or other surgeries for at least 3 months after your appointment?
Do you have other tattoos?
I agree that I have answered all of the above questions truthfully and to the best of my knowledge. I understand that if I did not, anything can pose a risk to my permanent makeup procedure and could alter my results, resulting in infection or other possible risks. I understand that if I did not, and come to my appointment with anything that would prohibit my artist to proceed with the procedure that a cancellation fee of 35% of the service booked will be due before leaving the appointment and I will need to reschedule to a later date and/or take any action necessary before rescheduling, based on the case.*
Yes I am aware, agree and acknowledge.
No
Post Procedure Care for PMU Procedure. Results vary based on the "canvas" (your skin) that they are performed on. Lifestyle, medications, smoking, metabolism, facial surgery and other procedures, and age of skin all contribute to fading, color change over time. In some cases PMU can turn red, blue, or other colors depending on your skin and how it heals. There are color correctors that can fix the discoloration over time. I understand that I accept such risks. Though rare, infection is possible. If you see signs of infection such as persistent increased redness or swelling, fever, drainage, or oozing, contact your doctor immediately. When the area starts to flake, leave it. Do not pick, peel or pull on the skin whatsoever. Let the scabs or flakes come off naturally on its own.• Wash area lightly with mild foamy soap and finger tips every 3 hours, 2-3 times for the first day directly after the procedure, pat dry well, then apply a very thin layer of aftercare ointment (provided to you by your technician) to the area as advised. Day 2, wash the area lightly only morning and night, pat dry well, then apply a very thin layer or healing ointment. Day 3 STOP THE CLEANING, and only use the healing ointment morning, afternoon, and night as needed. If you apply it in the morning and by the afternoon there is still ointment on there, there is no need to reapply it. Over applying the healing ointment or putting too much on can cause your results to blur or heal correctly. It's very important to only apply a very very thin layer of ointment when using the healing ointment. Continue applying the healing ointment (morning, afternoon and night as needed) from day 4 and on for about 3 weeks or until healed. You should have enough healing ointment for your healing process after the first appointment AND for your healing process after the 6 week touch up which will be the same healing process/aftercare instructions. This will help you realize how little ointment you need to use and to not over apply. • Avoid sweating such as from vigorous exercise for 3 weeks. For at least 2/3 weeks post-procedure or until healing is complete: Keep your hands clean and avoid touching the affected area(s). Do not scrub or pick treated areas, Do not use peroxide or Neosporin on treated areas, Do not expose area to direct sun or to tanning beds, Avoid exposing the area to excessive moisture or humidity, such as: facials, swimming, whirlpools (hot tubs), saunas, steam rooms, and steamy showers. • Avoid Retin-A, moisturizers, glycolic acids, exfoliants and anti-aging products at all times (not just during healing) on all microbladed/shaded areas. These can cause pigments to fade and lighten prematurely. • Avoid tanning beds, sun, chlorine spas and pools, soap and chemicals (including skin cleansers, makeupremovers, alpha hydroxyl creams, and tooth whitening toothpaste) near the treated area until healed. • Pigments will slowly fade overtime according to one's metabolism, skin type, sun exposure, medication, facial surgery, and smoking. Schedule maintenance visits as needed to keep it looking fresh (no sooner than 12-18 months from your original appointment). • Periodic colorboosts will ensure longer lasting results however getting a colorboost too soon is unnecessary. If you're unsure if you're ready for a colorboost please contact me directly and send photos of your current brows. • Do not resume any method of eyebrow hair removal or coloration for at least 3 weeks. • Avoid eyebrow tinting within two weeks before or after the procedure. Do not apply any makeup, self tanners, spray tan, sunscreen or any other facial products, ect on or around your brows for at least 3-4 weeks until healed. Do not get them wet or sweat on them for at least 3-4 weeks until healed. I agree that I have been made aware of the aftercare instructions and have read through thoroughly. I am aware that by not following the aftercare instructions carefully, that it can alter my healed results due to my own negligence. You will also be given these instructions verbally at your appointment and can ask any questions at the appointment about the aftercare. I agree I have read and agree to follow these instructions carefully.*
Yes I have read and understand/agree with the above information.
No
Microblading/powder brow Healing scheduleOne of the most common questions we're asked is what to expect during the healing process. While every person is different and some heal more quickly or slowly than others, here's generally what to expect. Temporary side effects from micropigmentation include but are not limited to: redness, swelling, puffiness, bruising, dry patches and tenderness. You should expect to lose approximately 1/3 of the initial color during the healing process. We have selected the optimal pigments for you with this in mind. The first couple of days they may get extremely dark. In approximately six days or more it may appear too light. After about 10 days, the color will show more. It will appear softer when completely healed. Day 1 The eyebrows are approximately 20- 25% bolder and darker in width than they will be when healed. Expect light to moderate swelling and redness. The skin's redness causes the color of the pigment to appear darker. There is some swelling, although difficult to actually see due to the thickness of the skin in the eyebrow area. This will subside. New skin will heal over the pigmented area and result in a softer appearance of your eyebrows. Don't be concerned that your eyebrows initially appear darker and heavier in size than you desire. This is all part of the process. Eyebrows may start to itch. The skin begins to flake, peeling from the outside edges first. Color finishes flaking off and appears softer and grayer for a few days until color clarifies. The color has lightened from its initial overly-dark appearance. For the next few days, the color may now be lighter than what the final color will be. The final color begins to stabilize and show through. The color will continue to soften as the healing process completes. I UNDERSTAND AND ACCEPT THAT FAILURE TO FOLLOW THE POST-PROCEDURE INSTRUCTIONS ABOVE MAY RESULT IN A LOSS OR DISCOLORATION OF PIGMENT RESULTING IN A NEED FOR MORE FREQUENT TOUCHUPS OR LESS THAN DESIRED RESULTS. I agree I have read through this carefully.*
Yes I am aware, agree, acknowledge and understand the above information.
No
The Client acknowledges receipt of pre-procedure information and post-procedure (aftercare) instructions from the Specialist, and agrees that they have read them, have been advised of them, understand them, and agree to adhere to them in order to help ensure satisfactory results from the procedure(s) and help prevent secondary infection. The Client acknowledges that all final adjustments and detail work will be done in the second session, and will schedule a follow-up session with the Specialist 6 weeks of the procedure(s).*
Yes I am aware, agree and acknowledge
No

By signing below this line, I acknowledge that I have thoroughly read the entirety of this form, that I understand the terms contained herein, that I agree to adhere to any and all pre and post procedure directions, and that my answers were accurate and honest.
Sixth Client's Name

First Name*

Middle Name

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

Date of Scheduled Appointment *

Email Address *
Check list of things NOT to do/take at least 48 hours to 2 weeks prior to your appointment. *
By checking the boxes below next to each statement, I confirm that I have read and fully understand each item/statement made and that I am solely and personally responsible for avoiding or undertaking the following actions to ensure my own safety.
I understand I cannot drink alcohol or caffeine at least 24 hours before appointment.
I understand I cannot take ibuprofen, aspirin, fish oil or any other medications that will thin my blood at least 48 hours before my appointment.
I understand I should not take or self tan at least 2 weeks prior to my appointment. If self tanning please avoid the face area as we want to see your natural skin tone as much as possible.
I understand I need to come to my appointment with no makeup on
I understand I should not wax, tweeze, thread or remove any brow hair for at least 2 weeks before your appointment. We will need to see where all of your hair growth is.
I understand I cannot get botox for at least 2 weeks prior to my appointment.
I am aware of, and I agree to the following: The Microblading, or Powder Brows procedure, is a type of cosmetic tattooing. Usually, the healing period lasts between 2-4 weeks. A second visit is usually required thereafter at about 6 weeks. In some cases, more visits may be needed. During the healing period, redness, swelling, scabbing of the kind, irritation, itching, minor bleeding, and other effects may occur. I am aware that the final result will be achieved anywhere from 6-8 weeks following my last visit. *
Yes, I am aware, agree and acknowledge.
No
I am aware that the results of this desired cosmetic procedure can be affected by the following items or actions, including, but not limited to, medications, skin type, smoking, drug and alcohol use, the use of cosmetic skin care products and makeup on the eyebrow area, activities causing sweating or perspiration, eyebrow plucking, cosmetic surgery, and use of cosmetic injections. Further, I understand that if I am on any medications that I believe may impact the results of this cosmetic procedure, that it is my responsibility to consult a doctor prior to proceeding with any procedure *
Yes I am aware, agree and acknowledge.
No
I am aware that the results can be affected by: medication, skin type, smoking, drug and alcohol use, use of cosmetic skin care products and makeup on the eyebrow area, activities causing sweating, eyebrow plucking, cosmetic surgery, use of cosmetic injections and many other factors.*
Yes I am aware, agree and acknowledge.
No
I am aware that the pigments after initial procedure may partially and/or fully fade and/or disappear and full success cannot be guaranteed which is why the second visit (touch up) is highly recommended. I am aware that if I do not complete the process by scheduling and coming to the 6 week touch up, my results may not last the 1-3 years or longer that I was originally made aware of. I am aware that by not completing the touch up my results may only last (but not limited to) up to 6 months or less.*
Yes I am aware, agree and acknowledge.
No
I acknowledge that the final color and shade will be achieved after 6-8 weeks after the touch up and the pigment colors and shade may vary with time.*
Yes, I am aware, agree and acknowledge.
No
I understand that in some cases, numbing topical cream may be necessary. I further understand that it may cause some level of sensitivity, discomfort, allergic reaction, redness, swelling or other reactions, depending on the skin type and sensitivity*
Yes, I am aware, agree and acknowledge
No
I am aware of the risks of possible allergic reactions, infections and any other complications as a result of the procedure, especially if I do not take care of the eyebrows or follow proper aftercare instructions, and the skin in that area. In extremely rare cases some scarring is possible. I accept such risks and accept full responsibility for any post treatment complication. I informed the practitioner of my known allergies.*
Yes I am aware, agree and acknowledge
No
I acknowledge that the correcting and the revision of any type of existing permanent makeup, tattoo etc, previously performed by other providers involves additional risks due to unknown factors, such as but not limited to, brand, color, time, skin reaction, depth and others and the practitioner has no full control over the potential results and I accept full responsibility for the final outcome and complications.*
Yes I am aware, agree and acknowledge
No
I understand the following medical conditions require consent from the doctor:Diabetes, HIV, hepatitis, high blood pressure, thyroid disease, herpes, have a history of MRSA or staph infection, have any type of abnormal heart conditions, any type of autoimmune disorders, have any type of blood diseases, have glaucoma, have trichotillomania, alopecia, hemophilia, leukemia, anemia and any other blood disorders, any type of cancer, nursing and any type of liver disorders, have had any type of surgeries in the past 12 months, or under a doctors care for any particular condition. I will not hold Katie Riddle ( beautybykatiellc) liable if I choose not to get consent from my doctor. I am aware I cannot get microblading/powder brows if I am pregnant.*
I am aware/agree and acknowledge and do NOT have any of these conditions that I need to get consent from my doctors approval for.
I will need to get consent from my doctor for one or more of these conditions and will let my artist know upon approval/ disapproval as soon as possible before my appointment to avoid last minute cancellations due to the possibility of non approval from my doctor. I am aware that any last minute cancellations due to disapproval is still subject to cancellation fees within 48 hours.
I am aware that I will have the opportunity to approve the shape created by my artist provider before doing anything permanent therefore if I am unhappy with the shape, I am fully aware that I approved it before beginning. I give my consent to use Permanent Makeup tools/machine to apply pigments into my skin in the eyebrow area and modify the look of my existing eyebrows.*
Yes I am aware, agree and acknowledge.
No
I hereby agree that I will not make any oral or written statement about my artist provider, her business, or staff, which is intended or reasonably likely to disparage her, her business, or any of her staff members, or that degrades her, its, their, reputation(s) in any way. This includes, but is not limited to, any disparaging oral or written statements posted on social media platforms.*
Yes I am aware, agree, and acknowledge.
No
I consent or waive the patch test. If waived, I release the technician from liability if I develop an allergic reaction to the pigments or products. A Patch test is where we take a small amount of the products we would use for the permanent makeup procedure and dot a few spots behind your ear, in your hair line. -I understand that allergic reactions such as stinging or burning sensations on the treating area or surrounding area, including the eyes, may occur. -I understand that an allergic reaction can occur at any time, even if I have received this service on previous occasions. -I understand that if I develop any allergic reaction, I must rinse with cold water, avoid using perfume or makeup products on the area, and should seek immediate medical attention. - I understand that a negative patch test does not guarantee that I will not have an adverse reaction to services performed.*
I would like a patch test prior to my appointment and understand this must be done 48 hours prior to my appointment and will reach out to Katie about doing the patch test.
I do not want a patch test.
I am over the age of 18*
No
Yes
I have not gotten botox in or around my face or head in 2 weeks and am aware that if I am dishonest about this that it can alter my microblading/powder brow results/shape. I agree I will not get Botox for at least 2 weeks prior to my appointment.*
No, I have to get Botox 2 weeks prior and am aware this will mean the cancelation of my PMU appointment.
Yes I am aware, agree and acknowledge that I cannot and will not get botox 2 weeks prior to my appointment.
The client fully, and voluntarily, consents to have the Specialist perform the permanent cosmetic procedure(s), and is fully aware and informed of all and any inherent risks, dangers, and complications associated with having permanent cosmetic facial tattoo procedures performed. The client has had any questions or concerns which he/she has expressed satisfactorily answered or resolved by the Specialist.*
Yes I am aware, agree and acknowledge.
No
The Client, realizing that cosmetic procedures of the type of those specified in this agreement are fraught with risks and dangers which cannot be eliminated from the process regardless of the precautions and safeguards which are undertaken, hereby agrees that the client releases the Specialist from any and all claims, damages, and liability of all types relating to the performance of the specified procedure(s), including any costs of medical care or assistance required by the Client as a result of the procedure(s) performed, which shall include any post-operative care, repair or reconstruction which the Client may require or desire. This release agreement by the client shall also extend to the proprietors, officers, agents, and employees of any business Specialist that is employed by or associated with performing the cosmetic procedure(s)*
Yes I am aware, agree and acknowledge.
No
I acknowledge it is not reasonably possible for the representatives and employees of this permanent makeup salon to determine whether I might have an allergic reaction to the pigments or processes used in my procedure, and I agree to accept the risk that such a reaction is possible. I am aware I will not receive ANY refunds for any allergic reaction to the PMU procedure.*
Yes I am aware, agree and acknowledge
No
I acknowledge that infection is always possible as a result of the obtaining of a permanent makeup, particularly in the event that I do not take proper care of my permanent makeup. I have received aftercare instructions and I agree to follow them carefully while my permanent makeup is healing. I agree that any touch-up work needed outside of the normal 6 week touch up, due to my own negligence, will be done at my own expense. I understand that if I do not follow the aftercare instructions carefully at my own negligence, my results may not be what was expected and I will not hold my artist responsible for such actions that were done by me.*
Yes I am aware, agree and acknowledge
No
I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my permanent makeup .*
Yes I am aware, agree and acknowledge
No
I understand that it is necessary for me to let my brow hair grow out as much as possible and I agree that I will not pluck, thread, wax, or remove any hair at least 2 weeks prior to my appointment. This is necessary to getting the proper shape for your brow and to avoid applying too much strokes/shading in areas that do naturally grow hair. I understand and am aware that if I do not follow this advice I may have less than satisfied results and will not blame my artist.*
Yes I am aware, agree and acknowledge.
No
I agree to release and forever discharge and hold harmless the Artist and all employees from any and all claims, damages or legal actions arising from or connected in any way with my permanent makeup , or the procedure and conduct used in my permanent makeup .*
Yes I am aware, agree and acknowledge.
No
I am aware that I cannot get the procedure done if I have been to the tanning bed/ or had natural sun at least two weeks or less prior to my appointment or if I have self tanner on my face at the appointment. Some tan is fine but we want to see your natural skin tone as much as possible so please do not lay out, go to the tanning bed, or self tan/spray tan for at least 2 weeks prior to your permanent makeup appointment.*
Yes I am aware, agree and acknowledge
No
I am aware that I cannot take any blood thinning medications such as Aspirin, Ibuprofen, Alcohol, Coumadin ect, at least 48 hours prior to my appointment. I am aware that by doing so this can affect the shape and healed results if too much blood is covering the pre-dran shade during the procedure. This could even result in the artist being forced to stop the procedure and reschedule your appointment. In a rare case as this, the cancelation fee would apply for the current appointment and a new full charge appointment will be necessary to complete the service.*
Yes I am aware, agree and acknowledge
No
I understand that it is my responsibility to ask questions about any information contained herein that I do not understand or is confusing to me and that I must do so prior to submitting this form. I understand that my submission of this form represents that I did not have any questions and that I fully understand all content. If I arrive to my appointment with anything that would prohibit my artist to proceed with the procedure, I hereby agree to pay a cancellation fee amounting to 35% of the services I booked which is due to my artist prior to leaving the scheduled appointment. If this should happen, I understand that I will need to reschedule my appointment for a later date and take any action necessary prior to me rescheduling my appointment.*
No
Yes I am aware, agree and acknowledge
Clients Medical History/misc. PLEASE ONLY CLICK THE BOXES IF YOU ARE ANSWERING YES TO THE QUESTION. by not clicking the boxes you are answering no.
Do you have a history of MRSA?
Have you/ will you have had Botox 2 weeks or sooner to your appointment?
Do you have diabetes?
Do you have hepatitis A B C D?
Have you had a brow lift or facelift?
Do you typically bleed easily?
Are you/ will you be under the influence of alcohol or drugs during your appointment?
Do you have any abnormal heart conditions?
Do you take medication before dental work?
Have you/will you have had a chemical peel within two weeks from your PMU appointment?
Are you pregnant or breatfeeding?
Have you had any brow or lash tinting?
Do you have an autoimmune disorder?
Are you currently being treated for cancer or been treated for it in the last 12 months?
Are you currently taking Accutane or acne treatments?
Are you under treatment of chemotherapy or radiation?
Do you have any tumors or cysts?
Have you/ will you have taken any blood thinning medications such as; Aspirin, Ibuprofen, Alcohol, Coumadin etc 48 hour or less than before your appointment?
Have you ever had any Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylene Glycol, Vitamin E Acetate, etc?
Do you use skin care products containing Retin-A, Glycolic Acid, or Alpha Hydroxyl? Please do not use these 48 hours prior to your appointment to avoid sensitivity.
Do you have any heart conditions?
Do you have a mitral or prolapsed heart valve
Do you have any joint replacements?
Do you have any type of blood diseases?
Are you hemophiliac?
Are you epileptic or subject to seizures?
Do you have glaucoma?
Do you have any dermatological disorders (eczema, rosacea, psoriasis, dermatitis, shingles, etc.)
Do you have herpes?
Do you have (or are you prone to) keloid formation?
Do you have trichotillomania?
Do you have alopecia?
Do you use steroids?
Do you have Tourette's syndrome or are you prone to nervous ticks?
Are you planning to have any cosmetic or other surgeries for at least 3 months after your appointment?
Do you have other tattoos?
I agree that I have answered all of the above questions truthfully and to the best of my knowledge. I understand that if I did not, anything can pose a risk to my permanent makeup procedure and could alter my results, resulting in infection or other possible risks. I understand that if I did not, and come to my appointment with anything that would prohibit my artist to proceed with the procedure that a cancellation fee of 35% of the service booked will be due before leaving the appointment and I will need to reschedule to a later date and/or take any action necessary before rescheduling, based on the case.*
Yes I am aware, agree and acknowledge.
No
Post Procedure Care for PMU Procedure. Results vary based on the "canvas" (your skin) that they are performed on. Lifestyle, medications, smoking, metabolism, facial surgery and other procedures, and age of skin all contribute to fading, color change over time. In some cases PMU can turn red, blue, or other colors depending on your skin and how it heals. There are color correctors that can fix the discoloration over time. I understand that I accept such risks. Though rare, infection is possible. If you see signs of infection such as persistent increased redness or swelling, fever, drainage, or oozing, contact your doctor immediately. When the area starts to flake, leave it. Do not pick, peel or pull on the skin whatsoever. Let the scabs or flakes come off naturally on its own.• Wash area lightly with mild foamy soap and finger tips every 3 hours, 2-3 times for the first day directly after the procedure, pat dry well, then apply a very thin layer of aftercare ointment (provided to you by your technician) to the area as advised. Day 2, wash the area lightly only morning and night, pat dry well, then apply a very thin layer or healing ointment. Day 3 STOP THE CLEANING, and only use the healing ointment morning, afternoon, and night as needed. If you apply it in the morning and by the afternoon there is still ointment on there, there is no need to reapply it. Over applying the healing ointment or putting too much on can cause your results to blur or heal correctly. It's very important to only apply a very very thin layer of ointment when using the healing ointment. Continue applying the healing ointment (morning, afternoon and night as needed) from day 4 and on for about 3 weeks or until healed. You should have enough healing ointment for your healing process after the first appointment AND for your healing process after the 6 week touch up which will be the same healing process/aftercare instructions. This will help you realize how little ointment you need to use and to not over apply. • Avoid sweating such as from vigorous exercise for 3 weeks. For at least 2/3 weeks post-procedure or until healing is complete: Keep your hands clean and avoid touching the affected area(s). Do not scrub or pick treated areas, Do not use peroxide or Neosporin on treated areas, Do not expose area to direct sun or to tanning beds, Avoid exposing the area to excessive moisture or humidity, such as: facials, swimming, whirlpools (hot tubs), saunas, steam rooms, and steamy showers. • Avoid Retin-A, moisturizers, glycolic acids, exfoliants and anti-aging products at all times (not just during healing) on all microbladed/shaded areas. These can cause pigments to fade and lighten prematurely. • Avoid tanning beds, sun, chlorine spas and pools, soap and chemicals (including skin cleansers, makeupremovers, alpha hydroxyl creams, and tooth whitening toothpaste) near the treated area until healed. • Pigments will slowly fade overtime according to one's metabolism, skin type, sun exposure, medication, facial surgery, and smoking. Schedule maintenance visits as needed to keep it looking fresh (no sooner than 12-18 months from your original appointment). • Periodic colorboosts will ensure longer lasting results however getting a colorboost too soon is unnecessary. If you're unsure if you're ready for a colorboost please contact me directly and send photos of your current brows. • Do not resume any method of eyebrow hair removal or coloration for at least 3 weeks. • Avoid eyebrow tinting within two weeks before or after the procedure. Do not apply any makeup, self tanners, spray tan, sunscreen or any other facial products, ect on or around your brows for at least 3-4 weeks until healed. Do not get them wet or sweat on them for at least 3-4 weeks until healed. I agree that I have been made aware of the aftercare instructions and have read through thoroughly. I am aware that by not following the aftercare instructions carefully, that it can alter my healed results due to my own negligence. You will also be given these instructions verbally at your appointment and can ask any questions at the appointment about the aftercare. I agree I have read and agree to follow these instructions carefully.*
Yes I have read and understand/agree with the above information.
No
Microblading/powder brow Healing scheduleOne of the most common questions we're asked is what to expect during the healing process. While every person is different and some heal more quickly or slowly than others, here's generally what to expect. Temporary side effects from micropigmentation include but are not limited to: redness, swelling, puffiness, bruising, dry patches and tenderness. You should expect to lose approximately 1/3 of the initial color during the healing process. We have selected the optimal pigments for you with this in mind. The first couple of days they may get extremely dark. In approximately six days or more it may appear too light. After about 10 days, the color will show more. It will appear softer when completely healed. Day 1 The eyebrows are approximately 20- 25% bolder and darker in width than they will be when healed. Expect light to moderate swelling and redness. The skin's redness causes the color of the pigment to appear darker. There is some swelling, although difficult to actually see due to the thickness of the skin in the eyebrow area. This will subside. New skin will heal over the pigmented area and result in a softer appearance of your eyebrows. Don't be concerned that your eyebrows initially appear darker and heavier in size than you desire. This is all part of the process. Eyebrows may start to itch. The skin begins to flake, peeling from the outside edges first. Color finishes flaking off and appears softer and grayer for a few days until color clarifies. The color has lightened from its initial overly-dark appearance. For the next few days, the color may now be lighter than what the final color will be. The final color begins to stabilize and show through. The color will continue to soften as the healing process completes. I UNDERSTAND AND ACCEPT THAT FAILURE TO FOLLOW THE POST-PROCEDURE INSTRUCTIONS ABOVE MAY RESULT IN A LOSS OR DISCOLORATION OF PIGMENT RESULTING IN A NEED FOR MORE FREQUENT TOUCHUPS OR LESS THAN DESIRED RESULTS. I agree I have read through this carefully.*
Yes I am aware, agree, acknowledge and understand the above information.
No
The Client acknowledges receipt of pre-procedure information and post-procedure (aftercare) instructions from the Specialist, and agrees that they have read them, have been advised of them, understand them, and agree to adhere to them in order to help ensure satisfactory results from the procedure(s) and help prevent secondary infection. The Client acknowledges that all final adjustments and detail work will be done in the second session, and will schedule a follow-up session with the Specialist 6 weeks of the procedure(s).*
Yes I am aware, agree and acknowledge
No

By signing below this line, I acknowledge that I have thoroughly read the entirety of this form, that I understand the terms contained herein, that I agree to adhere to any and all pre and post procedure directions, and that my answers were accurate and honest.
Seventh Client's Name

First Name*

Middle Name

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

Date of Scheduled Appointment *

Email Address *
Check list of things NOT to do/take at least 48 hours to 2 weeks prior to your appointment. *
By checking the boxes below next to each statement, I confirm that I have read and fully understand each item/statement made and that I am solely and personally responsible for avoiding or undertaking the following actions to ensure my own safety.
I understand I cannot drink alcohol or caffeine at least 24 hours before appointment.
I understand I cannot take ibuprofen, aspirin, fish oil or any other medications that will thin my blood at least 48 hours before my appointment.
I understand I should not take or self tan at least 2 weeks prior to my appointment. If self tanning please avoid the face area as we want to see your natural skin tone as much as possible.
I understand I need to come to my appointment with no makeup on
I understand I should not wax, tweeze, thread or remove any brow hair for at least 2 weeks before your appointment. We will need to see where all of your hair growth is.
I understand I cannot get botox for at least 2 weeks prior to my appointment.
I am aware of, and I agree to the following: The Microblading, or Powder Brows procedure, is a type of cosmetic tattooing. Usually, the healing period lasts between 2-4 weeks. A second visit is usually required thereafter at about 6 weeks. In some cases, more visits may be needed. During the healing period, redness, swelling, scabbing of the kind, irritation, itching, minor bleeding, and other effects may occur. I am aware that the final result will be achieved anywhere from 6-8 weeks following my last visit. *
Yes, I am aware, agree and acknowledge.
No
I am aware that the results of this desired cosmetic procedure can be affected by the following items or actions, including, but not limited to, medications, skin type, smoking, drug and alcohol use, the use of cosmetic skin care products and makeup on the eyebrow area, activities causing sweating or perspiration, eyebrow plucking, cosmetic surgery, and use of cosmetic injections. Further, I understand that if I am on any medications that I believe may impact the results of this cosmetic procedure, that it is my responsibility to consult a doctor prior to proceeding with any procedure *
Yes I am aware, agree and acknowledge.
No
I am aware that the results can be affected by: medication, skin type, smoking, drug and alcohol use, use of cosmetic skin care products and makeup on the eyebrow area, activities causing sweating, eyebrow plucking, cosmetic surgery, use of cosmetic injections and many other factors.*
Yes I am aware, agree and acknowledge.
No
I am aware that the pigments after initial procedure may partially and/or fully fade and/or disappear and full success cannot be guaranteed which is why the second visit (touch up) is highly recommended. I am aware that if I do not complete the process by scheduling and coming to the 6 week touch up, my results may not last the 1-3 years or longer that I was originally made aware of. I am aware that by not completing the touch up my results may only last (but not limited to) up to 6 months or less.*
Yes I am aware, agree and acknowledge.
No
I acknowledge that the final color and shade will be achieved after 6-8 weeks after the touch up and the pigment colors and shade may vary with time.*
Yes, I am aware, agree and acknowledge.
No
I understand that in some cases, numbing topical cream may be necessary. I further understand that it may cause some level of sensitivity, discomfort, allergic reaction, redness, swelling or other reactions, depending on the skin type and sensitivity*
Yes, I am aware, agree and acknowledge
No
I am aware of the risks of possible allergic reactions, infections and any other complications as a result of the procedure, especially if I do not take care of the eyebrows or follow proper aftercare instructions, and the skin in that area. In extremely rare cases some scarring is possible. I accept such risks and accept full responsibility for any post treatment complication. I informed the practitioner of my known allergies.*
Yes I am aware, agree and acknowledge
No
I acknowledge that the correcting and the revision of any type of existing permanent makeup, tattoo etc, previously performed by other providers involves additional risks due to unknown factors, such as but not limited to, brand, color, time, skin reaction, depth and others and the practitioner has no full control over the potential results and I accept full responsibility for the final outcome and complications.*
Yes I am aware, agree and acknowledge
No
I understand the following medical conditions require consent from the doctor:Diabetes, HIV, hepatitis, high blood pressure, thyroid disease, herpes, have a history of MRSA or staph infection, have any type of abnormal heart conditions, any type of autoimmune disorders, have any type of blood diseases, have glaucoma, have trichotillomania, alopecia, hemophilia, leukemia, anemia and any other blood disorders, any type of cancer, nursing and any type of liver disorders, have had any type of surgeries in the past 12 months, or under a doctors care for any particular condition. I will not hold Katie Riddle ( beautybykatiellc) liable if I choose not to get consent from my doctor. I am aware I cannot get microblading/powder brows if I am pregnant.*
I am aware/agree and acknowledge and do NOT have any of these conditions that I need to get consent from my doctors approval for.
I will need to get consent from my doctor for one or more of these conditions and will let my artist know upon approval/ disapproval as soon as possible before my appointment to avoid last minute cancellations due to the possibility of non approval from my doctor. I am aware that any last minute cancellations due to disapproval is still subject to cancellation fees within 48 hours.
I am aware that I will have the opportunity to approve the shape created by my artist provider before doing anything permanent therefore if I am unhappy with the shape, I am fully aware that I approved it before beginning. I give my consent to use Permanent Makeup tools/machine to apply pigments into my skin in the eyebrow area and modify the look of my existing eyebrows.*
Yes I am aware, agree and acknowledge.
No
I hereby agree that I will not make any oral or written statement about my artist provider, her business, or staff, which is intended or reasonably likely to disparage her, her business, or any of her staff members, or that degrades her, its, their, reputation(s) in any way. This includes, but is not limited to, any disparaging oral or written statements posted on social media platforms.*
Yes I am aware, agree, and acknowledge.
No
I consent or waive the patch test. If waived, I release the technician from liability if I develop an allergic reaction to the pigments or products. A Patch test is where we take a small amount of the products we would use for the permanent makeup procedure and dot a few spots behind your ear, in your hair line. -I understand that allergic reactions such as stinging or burning sensations on the treating area or surrounding area, including the eyes, may occur. -I understand that an allergic reaction can occur at any time, even if I have received this service on previous occasions. -I understand that if I develop any allergic reaction, I must rinse with cold water, avoid using perfume or makeup products on the area, and should seek immediate medical attention. - I understand that a negative patch test does not guarantee that I will not have an adverse reaction to services performed.*
I would like a patch test prior to my appointment and understand this must be done 48 hours prior to my appointment and will reach out to Katie about doing the patch test.
I do not want a patch test.
I am over the age of 18*
No
Yes
I have not gotten botox in or around my face or head in 2 weeks and am aware that if I am dishonest about this that it can alter my microblading/powder brow results/shape. I agree I will not get Botox for at least 2 weeks prior to my appointment.*
No, I have to get Botox 2 weeks prior and am aware this will mean the cancelation of my PMU appointment.
Yes I am aware, agree and acknowledge that I cannot and will not get botox 2 weeks prior to my appointment.
The client fully, and voluntarily, consents to have the Specialist perform the permanent cosmetic procedure(s), and is fully aware and informed of all and any inherent risks, dangers, and complications associated with having permanent cosmetic facial tattoo procedures performed. The client has had any questions or concerns which he/she has expressed satisfactorily answered or resolved by the Specialist.*
Yes I am aware, agree and acknowledge.
No
The Client, realizing that cosmetic procedures of the type of those specified in this agreement are fraught with risks and dangers which cannot be eliminated from the process regardless of the precautions and safeguards which are undertaken, hereby agrees that the client releases the Specialist from any and all claims, damages, and liability of all types relating to the performance of the specified procedure(s), including any costs of medical care or assistance required by the Client as a result of the procedure(s) performed, which shall include any post-operative care, repair or reconstruction which the Client may require or desire. This release agreement by the client shall also extend to the proprietors, officers, agents, and employees of any business Specialist that is employed by or associated with performing the cosmetic procedure(s)*
Yes I am aware, agree and acknowledge.
No
I acknowledge it is not reasonably possible for the representatives and employees of this permanent makeup salon to determine whether I might have an allergic reaction to the pigments or processes used in my procedure, and I agree to accept the risk that such a reaction is possible. I am aware I will not receive ANY refunds for any allergic reaction to the PMU procedure.*
Yes I am aware, agree and acknowledge
No
I acknowledge that infection is always possible as a result of the obtaining of a permanent makeup, particularly in the event that I do not take proper care of my permanent makeup. I have received aftercare instructions and I agree to follow them carefully while my permanent makeup is healing. I agree that any touch-up work needed outside of the normal 6 week touch up, due to my own negligence, will be done at my own expense. I understand that if I do not follow the aftercare instructions carefully at my own negligence, my results may not be what was expected and I will not hold my artist responsible for such actions that were done by me.*
Yes I am aware, agree and acknowledge
No
I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my permanent makeup .*
Yes I am aware, agree and acknowledge
No
I understand that it is necessary for me to let my brow hair grow out as much as possible and I agree that I will not pluck, thread, wax, or remove any hair at least 2 weeks prior to my appointment. This is necessary to getting the proper shape for your brow and to avoid applying too much strokes/shading in areas that do naturally grow hair. I understand and am aware that if I do not follow this advice I may have less than satisfied results and will not blame my artist.*
Yes I am aware, agree and acknowledge.
No
I agree to release and forever discharge and hold harmless the Artist and all employees from any and all claims, damages or legal actions arising from or connected in any way with my permanent makeup , or the procedure and conduct used in my permanent makeup .*
Yes I am aware, agree and acknowledge.
No
I am aware that I cannot get the procedure done if I have been to the tanning bed/ or had natural sun at least two weeks or less prior to my appointment or if I have self tanner on my face at the appointment. Some tan is fine but we want to see your natural skin tone as much as possible so please do not lay out, go to the tanning bed, or self tan/spray tan for at least 2 weeks prior to your permanent makeup appointment.*
Yes I am aware, agree and acknowledge
No
I am aware that I cannot take any blood thinning medications such as Aspirin, Ibuprofen, Alcohol, Coumadin ect, at least 48 hours prior to my appointment. I am aware that by doing so this can affect the shape and healed results if too much blood is covering the pre-dran shade during the procedure. This could even result in the artist being forced to stop the procedure and reschedule your appointment. In a rare case as this, the cancelation fee would apply for the current appointment and a new full charge appointment will be necessary to complete the service.*
Yes I am aware, agree and acknowledge
No
I understand that it is my responsibility to ask questions about any information contained herein that I do not understand or is confusing to me and that I must do so prior to submitting this form. I understand that my submission of this form represents that I did not have any questions and that I fully understand all content. If I arrive to my appointment with anything that would prohibit my artist to proceed with the procedure, I hereby agree to pay a cancellation fee amounting to 35% of the services I booked which is due to my artist prior to leaving the scheduled appointment. If this should happen, I understand that I will need to reschedule my appointment for a later date and take any action necessary prior to me rescheduling my appointment.*
No
Yes I am aware, agree and acknowledge
Clients Medical History/misc. PLEASE ONLY CLICK THE BOXES IF YOU ARE ANSWERING YES TO THE QUESTION. by not clicking the boxes you are answering no.
Do you have a history of MRSA?
Have you/ will you have had Botox 2 weeks or sooner to your appointment?
Do you have diabetes?
Do you have hepatitis A B C D?
Have you had a brow lift or facelift?
Do you typically bleed easily?
Are you/ will you be under the influence of alcohol or drugs during your appointment?
Do you have any abnormal heart conditions?
Do you take medication before dental work?
Have you/will you have had a chemical peel within two weeks from your PMU appointment?
Are you pregnant or breatfeeding?
Have you had any brow or lash tinting?
Do you have an autoimmune disorder?
Are you currently being treated for cancer or been treated for it in the last 12 months?
Are you currently taking Accutane or acne treatments?
Are you under treatment of chemotherapy or radiation?
Do you have any tumors or cysts?
Have you/ will you have taken any blood thinning medications such as; Aspirin, Ibuprofen, Alcohol, Coumadin etc 48 hour or less than before your appointment?
Have you ever had any Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylene Glycol, Vitamin E Acetate, etc?
Do you use skin care products containing Retin-A, Glycolic Acid, or Alpha Hydroxyl? Please do not use these 48 hours prior to your appointment to avoid sensitivity.
Do you have any heart conditions?
Do you have a mitral or prolapsed heart valve
Do you have any joint replacements?
Do you have any type of blood diseases?
Are you hemophiliac?
Are you epileptic or subject to seizures?
Do you have glaucoma?
Do you have any dermatological disorders (eczema, rosacea, psoriasis, dermatitis, shingles, etc.)
Do you have herpes?
Do you have (or are you prone to) keloid formation?
Do you have trichotillomania?
Do you have alopecia?
Do you use steroids?
Do you have Tourette's syndrome or are you prone to nervous ticks?
Are you planning to have any cosmetic or other surgeries for at least 3 months after your appointment?
Do you have other tattoos?
I agree that I have answered all of the above questions truthfully and to the best of my knowledge. I understand that if I did not, anything can pose a risk to my permanent makeup procedure and could alter my results, resulting in infection or other possible risks. I understand that if I did not, and come to my appointment with anything that would prohibit my artist to proceed with the procedure that a cancellation fee of 35% of the service booked will be due before leaving the appointment and I will need to reschedule to a later date and/or take any action necessary before rescheduling, based on the case.*
Yes I am aware, agree and acknowledge.
No
Post Procedure Care for PMU Procedure. Results vary based on the "canvas" (your skin) that they are performed on. Lifestyle, medications, smoking, metabolism, facial surgery and other procedures, and age of skin all contribute to fading, color change over time. In some cases PMU can turn red, blue, or other colors depending on your skin and how it heals. There are color correctors that can fix the discoloration over time. I understand that I accept such risks. Though rare, infection is possible. If you see signs of infection such as persistent increased redness or swelling, fever, drainage, or oozing, contact your doctor immediately. When the area starts to flake, leave it. Do not pick, peel or pull on the skin whatsoever. Let the scabs or flakes come off naturally on its own.• Wash area lightly with mild foamy soap and finger tips every 3 hours, 2-3 times for the first day directly after the procedure, pat dry well, then apply a very thin layer of aftercare ointment (provided to you by your technician) to the area as advised. Day 2, wash the area lightly only morning and night, pat dry well, then apply a very thin layer or healing ointment. Day 3 STOP THE CLEANING, and only use the healing ointment morning, afternoon, and night as needed. If you apply it in the morning and by the afternoon there is still ointment on there, there is no need to reapply it. Over applying the healing ointment or putting too much on can cause your results to blur or heal correctly. It's very important to only apply a very very thin layer of ointment when using the healing ointment. Continue applying the healing ointment (morning, afternoon and night as needed) from day 4 and on for about 3 weeks or until healed. You should have enough healing ointment for your healing process after the first appointment AND for your healing process after the 6 week touch up which will be the same healing process/aftercare instructions. This will help you realize how little ointment you need to use and to not over apply. • Avoid sweating such as from vigorous exercise for 3 weeks. For at least 2/3 weeks post-procedure or until healing is complete: Keep your hands clean and avoid touching the affected area(s). Do not scrub or pick treated areas, Do not use peroxide or Neosporin on treated areas, Do not expose area to direct sun or to tanning beds, Avoid exposing the area to excessive moisture or humidity, such as: facials, swimming, whirlpools (hot tubs), saunas, steam rooms, and steamy showers. • Avoid Retin-A, moisturizers, glycolic acids, exfoliants and anti-aging products at all times (not just during healing) on all microbladed/shaded areas. These can cause pigments to fade and lighten prematurely. • Avoid tanning beds, sun, chlorine spas and pools, soap and chemicals (including skin cleansers, makeupremovers, alpha hydroxyl creams, and tooth whitening toothpaste) near the treated area until healed. • Pigments will slowly fade overtime according to one's metabolism, skin type, sun exposure, medication, facial surgery, and smoking. Schedule maintenance visits as needed to keep it looking fresh (no sooner than 12-18 months from your original appointment). • Periodic colorboosts will ensure longer lasting results however getting a colorboost too soon is unnecessary. If you're unsure if you're ready for a colorboost please contact me directly and send photos of your current brows. • Do not resume any method of eyebrow hair removal or coloration for at least 3 weeks. • Avoid eyebrow tinting within two weeks before or after the procedure. Do not apply any makeup, self tanners, spray tan, sunscreen or any other facial products, ect on or around your brows for at least 3-4 weeks until healed. Do not get them wet or sweat on them for at least 3-4 weeks until healed. I agree that I have been made aware of the aftercare instructions and have read through thoroughly. I am aware that by not following the aftercare instructions carefully, that it can alter my healed results due to my own negligence. You will also be given these instructions verbally at your appointment and can ask any questions at the appointment about the aftercare. I agree I have read and agree to follow these instructions carefully.*
Yes I have read and understand/agree with the above information.
No
Microblading/powder brow Healing scheduleOne of the most common questions we're asked is what to expect during the healing process. While every person is different and some heal more quickly or slowly than others, here's generally what to expect. Temporary side effects from micropigmentation include but are not limited to: redness, swelling, puffiness, bruising, dry patches and tenderness. You should expect to lose approximately 1/3 of the initial color during the healing process. We have selected the optimal pigments for you with this in mind. The first couple of days they may get extremely dark. In approximately six days or more it may appear too light. After about 10 days, the color will show more. It will appear softer when completely healed. Day 1 The eyebrows are approximately 20- 25% bolder and darker in width than they will be when healed. Expect light to moderate swelling and redness. The skin's redness causes the color of the pigment to appear darker. There is some swelling, although difficult to actually see due to the thickness of the skin in the eyebrow area. This will subside. New skin will heal over the pigmented area and result in a softer appearance of your eyebrows. Don't be concerned that your eyebrows initially appear darker and heavier in size than you desire. This is all part of the process. Eyebrows may start to itch. The skin begins to flake, peeling from the outside edges first. Color finishes flaking off and appears softer and grayer for a few days until color clarifies. The color has lightened from its initial overly-dark appearance. For the next few days, the color may now be lighter than what the final color will be. The final color begins to stabilize and show through. The color will continue to soften as the healing process completes. I UNDERSTAND AND ACCEPT THAT FAILURE TO FOLLOW THE POST-PROCEDURE INSTRUCTIONS ABOVE MAY RESULT IN A LOSS OR DISCOLORATION OF PIGMENT RESULTING IN A NEED FOR MORE FREQUENT TOUCHUPS OR LESS THAN DESIRED RESULTS. I agree I have read through this carefully.*
Yes I am aware, agree, acknowledge and understand the above information.
No
The Client acknowledges receipt of pre-procedure information and post-procedure (aftercare) instructions from the Specialist, and agrees that they have read them, have been advised of them, understand them, and agree to adhere to them in order to help ensure satisfactory results from the procedure(s) and help prevent secondary infection. The Client acknowledges that all final adjustments and detail work will be done in the second session, and will schedule a follow-up session with the Specialist 6 weeks of the procedure(s).*
Yes I am aware, agree and acknowledge
No

By signing below this line, I acknowledge that I have thoroughly read the entirety of this form, that I understand the terms contained herein, that I agree to adhere to any and all pre and post procedure directions, and that my answers were accurate and honest.
Eighth Client's Name

First Name*

Middle Name

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

Date of Scheduled Appointment *

Email Address *
Check list of things NOT to do/take at least 48 hours to 2 weeks prior to your appointment. *
By checking the boxes below next to each statement, I confirm that I have read and fully understand each item/statement made and that I am solely and personally responsible for avoiding or undertaking the following actions to ensure my own safety.
I understand I cannot drink alcohol or caffeine at least 24 hours before appointment.
I understand I cannot take ibuprofen, aspirin, fish oil or any other medications that will thin my blood at least 48 hours before my appointment.
I understand I should not take or self tan at least 2 weeks prior to my appointment. If self tanning please avoid the face area as we want to see your natural skin tone as much as possible.
I understand I need to come to my appointment with no makeup on
I understand I should not wax, tweeze, thread or remove any brow hair for at least 2 weeks before your appointment. We will need to see where all of your hair growth is.
I understand I cannot get botox for at least 2 weeks prior to my appointment.
I am aware of, and I agree to the following: The Microblading, or Powder Brows procedure, is a type of cosmetic tattooing. Usually, the healing period lasts between 2-4 weeks. A second visit is usually required thereafter at about 6 weeks. In some cases, more visits may be needed. During the healing period, redness, swelling, scabbing of the kind, irritation, itching, minor bleeding, and other effects may occur. I am aware that the final result will be achieved anywhere from 6-8 weeks following my last visit. *
Yes, I am aware, agree and acknowledge.
No
I am aware that the results of this desired cosmetic procedure can be affected by the following items or actions, including, but not limited to, medications, skin type, smoking, drug and alcohol use, the use of cosmetic skin care products and makeup on the eyebrow area, activities causing sweating or perspiration, eyebrow plucking, cosmetic surgery, and use of cosmetic injections. Further, I understand that if I am on any medications that I believe may impact the results of this cosmetic procedure, that it is my responsibility to consult a doctor prior to proceeding with any procedure *
Yes I am aware, agree and acknowledge.
No
I am aware that the results can be affected by: medication, skin type, smoking, drug and alcohol use, use of cosmetic skin care products and makeup on the eyebrow area, activities causing sweating, eyebrow plucking, cosmetic surgery, use of cosmetic injections and many other factors.*
Yes I am aware, agree and acknowledge.
No
I am aware that the pigments after initial procedure may partially and/or fully fade and/or disappear and full success cannot be guaranteed which is why the second visit (touch up) is highly recommended. I am aware that if I do not complete the process by scheduling and coming to the 6 week touch up, my results may not last the 1-3 years or longer that I was originally made aware of. I am aware that by not completing the touch up my results may only last (but not limited to) up to 6 months or less.*
Yes I am aware, agree and acknowledge.
No
I acknowledge that the final color and shade will be achieved after 6-8 weeks after the touch up and the pigment colors and shade may vary with time.*
Yes, I am aware, agree and acknowledge.
No
I understand that in some cases, numbing topical cream may be necessary. I further understand that it may cause some level of sensitivity, discomfort, allergic reaction, redness, swelling or other reactions, depending on the skin type and sensitivity*
Yes, I am aware, agree and acknowledge
No
I am aware of the risks of possible allergic reactions, infections and any other complications as a result of the procedure, especially if I do not take care of the eyebrows or follow proper aftercare instructions, and the skin in that area. In extremely rare cases some scarring is possible. I accept such risks and accept full responsibility for any post treatment complication. I informed the practitioner of my known allergies.*
Yes I am aware, agree and acknowledge
No
I acknowledge that the correcting and the revision of any type of existing permanent makeup, tattoo etc, previously performed by other providers involves additional risks due to unknown factors, such as but not limited to, brand, color, time, skin reaction, depth and others and the practitioner has no full control over the potential results and I accept full responsibility for the final outcome and complications.*
Yes I am aware, agree and acknowledge
No
I understand the following medical conditions require consent from the doctor:Diabetes, HIV, hepatitis, high blood pressure, thyroid disease, herpes, have a history of MRSA or staph infection, have any type of abnormal heart conditions, any type of autoimmune disorders, have any type of blood diseases, have glaucoma, have trichotillomania, alopecia, hemophilia, leukemia, anemia and any other blood disorders, any type of cancer, nursing and any type of liver disorders, have had any type of surgeries in the past 12 months, or under a doctors care for any particular condition. I will not hold Katie Riddle ( beautybykatiellc) liable if I choose not to get consent from my doctor. I am aware I cannot get microblading/powder brows if I am pregnant.*
I am aware/agree and acknowledge and do NOT have any of these conditions that I need to get consent from my doctors approval for.
I will need to get consent from my doctor for one or more of these conditions and will let my artist know upon approval/ disapproval as soon as possible before my appointment to avoid last minute cancellations due to the possibility of non approval from my doctor. I am aware that any last minute cancellations due to disapproval is still subject to cancellation fees within 48 hours.
I am aware that I will have the opportunity to approve the shape created by my artist provider before doing anything permanent therefore if I am unhappy with the shape, I am fully aware that I approved it before beginning. I give my consent to use Permanent Makeup tools/machine to apply pigments into my skin in the eyebrow area and modify the look of my existing eyebrows.*
Yes I am aware, agree and acknowledge.
No
I hereby agree that I will not make any oral or written statement about my artist provider, her business, or staff, which is intended or reasonably likely to disparage her, her business, or any of her staff members, or that degrades her, its, their, reputation(s) in any way. This includes, but is not limited to, any disparaging oral or written statements posted on social media platforms.*
Yes I am aware, agree, and acknowledge.
No
I consent or waive the patch test. If waived, I release the technician from liability if I develop an allergic reaction to the pigments or products. A Patch test is where we take a small amount of the products we would use for the permanent makeup procedure and dot a few spots behind your ear, in your hair line. -I understand that allergic reactions such as stinging or burning sensations on the treating area or surrounding area, including the eyes, may occur. -I understand that an allergic reaction can occur at any time, even if I have received this service on previous occasions. -I understand that if I develop any allergic reaction, I must rinse with cold water, avoid using perfume or makeup products on the area, and should seek immediate medical attention. - I understand that a negative patch test does not guarantee that I will not have an adverse reaction to services performed.*
I would like a patch test prior to my appointment and understand this must be done 48 hours prior to my appointment and will reach out to Katie about doing the patch test.
I do not want a patch test.
I am over the age of 18*
No
Yes
I have not gotten botox in or around my face or head in 2 weeks and am aware that if I am dishonest about this that it can alter my microblading/powder brow results/shape. I agree I will not get Botox for at least 2 weeks prior to my appointment.*
No, I have to get Botox 2 weeks prior and am aware this will mean the cancelation of my PMU appointment.
Yes I am aware, agree and acknowledge that I cannot and will not get botox 2 weeks prior to my appointment.
The client fully, and voluntarily, consents to have the Specialist perform the permanent cosmetic procedure(s), and is fully aware and informed of all and any inherent risks, dangers, and complications associated with having permanent cosmetic facial tattoo procedures performed. The client has had any questions or concerns which he/she has expressed satisfactorily answered or resolved by the Specialist.*
Yes I am aware, agree and acknowledge.
No
The Client, realizing that cosmetic procedures of the type of those specified in this agreement are fraught with risks and dangers which cannot be eliminated from the process regardless of the precautions and safeguards which are undertaken, hereby agrees that the client releases the Specialist from any and all claims, damages, and liability of all types relating to the performance of the specified procedure(s), including any costs of medical care or assistance required by the Client as a result of the procedure(s) performed, which shall include any post-operative care, repair or reconstruction which the Client may require or desire. This release agreement by the client shall also extend to the proprietors, officers, agents, and employees of any business Specialist that is employed by or associated with performing the cosmetic procedure(s)*
Yes I am aware, agree and acknowledge.
No
I acknowledge it is not reasonably possible for the representatives and employees of this permanent makeup salon to determine whether I might have an allergic reaction to the pigments or processes used in my procedure, and I agree to accept the risk that such a reaction is possible. I am aware I will not receive ANY refunds for any allergic reaction to the PMU procedure.*
Yes I am aware, agree and acknowledge
No
I acknowledge that infection is always possible as a result of the obtaining of a permanent makeup, particularly in the event that I do not take proper care of my permanent makeup. I have received aftercare instructions and I agree to follow them carefully while my permanent makeup is healing. I agree that any touch-up work needed outside of the normal 6 week touch up, due to my own negligence, will be done at my own expense. I understand that if I do not follow the aftercare instructions carefully at my own negligence, my results may not be what was expected and I will not hold my artist responsible for such actions that were done by me.*
Yes I am aware, agree and acknowledge
No
I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my permanent makeup .*
Yes I am aware, agree and acknowledge
No
I understand that it is necessary for me to let my brow hair grow out as much as possible and I agree that I will not pluck, thread, wax, or remove any hair at least 2 weeks prior to my appointment. This is necessary to getting the proper shape for your brow and to avoid applying too much strokes/shading in areas that do naturally grow hair. I understand and am aware that if I do not follow this advice I may have less than satisfied results and will not blame my artist.*
Yes I am aware, agree and acknowledge.
No
I agree to release and forever discharge and hold harmless the Artist and all employees from any and all claims, damages or legal actions arising from or connected in any way with my permanent makeup , or the procedure and conduct used in my permanent makeup .*
Yes I am aware, agree and acknowledge.
No
I am aware that I cannot get the procedure done if I have been to the tanning bed/ or had natural sun at least two weeks or less prior to my appointment or if I have self tanner on my face at the appointment. Some tan is fine but we want to see your natural skin tone as much as possible so please do not lay out, go to the tanning bed, or self tan/spray tan for at least 2 weeks prior to your permanent makeup appointment.*
Yes I am aware, agree and acknowledge
No
I am aware that I cannot take any blood thinning medications such as Aspirin, Ibuprofen, Alcohol, Coumadin ect, at least 48 hours prior to my appointment. I am aware that by doing so this can affect the shape and healed results if too much blood is covering the pre-dran shade during the procedure. This could even result in the artist being forced to stop the procedure and reschedule your appointment. In a rare case as this, the cancelation fee would apply for the current appointment and a new full charge appointment will be necessary to complete the service.*
Yes I am aware, agree and acknowledge
No
I understand that it is my responsibility to ask questions about any information contained herein that I do not understand or is confusing to me and that I must do so prior to submitting this form. I understand that my submission of this form represents that I did not have any questions and that I fully understand all content. If I arrive to my appointment with anything that would prohibit my artist to proceed with the procedure, I hereby agree to pay a cancellation fee amounting to 35% of the services I booked which is due to my artist prior to leaving the scheduled appointment. If this should happen, I understand that I will need to reschedule my appointment for a later date and take any action necessary prior to me rescheduling my appointment.*
No
Yes I am aware, agree and acknowledge
Clients Medical History/misc. PLEASE ONLY CLICK THE BOXES IF YOU ARE ANSWERING YES TO THE QUESTION. by not clicking the boxes you are answering no.
Do you have a history of MRSA?
Have you/ will you have had Botox 2 weeks or sooner to your appointment?
Do you have diabetes?
Do you have hepatitis A B C D?
Have you had a brow lift or facelift?
Do you typically bleed easily?
Are you/ will you be under the influence of alcohol or drugs during your appointment?
Do you have any abnormal heart conditions?
Do you take medication before dental work?
Have you/will you have had a chemical peel within two weeks from your PMU appointment?
Are you pregnant or breatfeeding?
Have you had any brow or lash tinting?
Do you have an autoimmune disorder?
Are you currently being treated for cancer or been treated for it in the last 12 months?
Are you currently taking Accutane or acne treatments?
Are you under treatment of chemotherapy or radiation?
Do you have any tumors or cysts?
Have you/ will you have taken any blood thinning medications such as; Aspirin, Ibuprofen, Alcohol, Coumadin etc 48 hour or less than before your appointment?
Have you ever had any Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylene Glycol, Vitamin E Acetate, etc?
Do you use skin care products containing Retin-A, Glycolic Acid, or Alpha Hydroxyl? Please do not use these 48 hours prior to your appointment to avoid sensitivity.
Do you have any heart conditions?
Do you have a mitral or prolapsed heart valve
Do you have any joint replacements?
Do you have any type of blood diseases?
Are you hemophiliac?
Are you epileptic or subject to seizures?
Do you have glaucoma?
Do you have any dermatological disorders (eczema, rosacea, psoriasis, dermatitis, shingles, etc.)
Do you have herpes?
Do you have (or are you prone to) keloid formation?
Do you have trichotillomania?
Do you have alopecia?
Do you use steroids?
Do you have Tourette's syndrome or are you prone to nervous ticks?
Are you planning to have any cosmetic or other surgeries for at least 3 months after your appointment?
Do you have other tattoos?
I agree that I have answered all of the above questions truthfully and to the best of my knowledge. I understand that if I did not, anything can pose a risk to my permanent makeup procedure and could alter my results, resulting in infection or other possible risks. I understand that if I did not, and come to my appointment with anything that would prohibit my artist to proceed with the procedure that a cancellation fee of 35% of the service booked will be due before leaving the appointment and I will need to reschedule to a later date and/or take any action necessary before rescheduling, based on the case.*
Yes I am aware, agree and acknowledge.
No
Post Procedure Care for PMU Procedure. Results vary based on the "canvas" (your skin) that they are performed on. Lifestyle, medications, smoking, metabolism, facial surgery and other procedures, and age of skin all contribute to fading, color change over time. In some cases PMU can turn red, blue, or other colors depending on your skin and how it heals. There are color correctors that can fix the discoloration over time. I understand that I accept such risks. Though rare, infection is possible. If you see signs of infection such as persistent increased redness or swelling, fever, drainage, or oozing, contact your doctor immediately. When the area starts to flake, leave it. Do not pick, peel or pull on the skin whatsoever. Let the scabs or flakes come off naturally on its own.• Wash area lightly with mild foamy soap and finger tips every 3 hours, 2-3 times for the first day directly after the procedure, pat dry well, then apply a very thin layer of aftercare ointment (provided to you by your technician) to the area as advised. Day 2, wash the area lightly only morning and night, pat dry well, then apply a very thin layer or healing ointment. Day 3 STOP THE CLEANING, and only use the healing ointment morning, afternoon, and night as needed. If you apply it in the morning and by the afternoon there is still ointment on there, there is no need to reapply it. Over applying the healing ointment or putting too much on can cause your results to blur or heal correctly. It's very important to only apply a very very thin layer of ointment when using the healing ointment. Continue applying the healing ointment (morning, afternoon and night as needed) from day 4 and on for about 3 weeks or until healed. You should have enough healing ointment for your healing process after the first appointment AND for your healing process after the 6 week touch up which will be the same healing process/aftercare instructions. This will help you realize how little ointment you need to use and to not over apply. • Avoid sweating such as from vigorous exercise for 3 weeks. For at least 2/3 weeks post-procedure or until healing is complete: Keep your hands clean and avoid touching the affected area(s). Do not scrub or pick treated areas, Do not use peroxide or Neosporin on treated areas, Do not expose area to direct sun or to tanning beds, Avoid exposing the area to excessive moisture or humidity, such as: facials, swimming, whirlpools (hot tubs), saunas, steam rooms, and steamy showers. • Avoid Retin-A, moisturizers, glycolic acids, exfoliants and anti-aging products at all times (not just during healing) on all microbladed/shaded areas. These can cause pigments to fade and lighten prematurely. • Avoid tanning beds, sun, chlorine spas and pools, soap and chemicals (including skin cleansers, makeupremovers, alpha hydroxyl creams, and tooth whitening toothpaste) near the treated area until healed. • Pigments will slowly fade overtime according to one's metabolism, skin type, sun exposure, medication, facial surgery, and smoking. Schedule maintenance visits as needed to keep it looking fresh (no sooner than 12-18 months from your original appointment). • Periodic colorboosts will ensure longer lasting results however getting a colorboost too soon is unnecessary. If you're unsure if you're ready for a colorboost please contact me directly and send photos of your current brows. • Do not resume any method of eyebrow hair removal or coloration for at least 3 weeks. • Avoid eyebrow tinting within two weeks before or after the procedure. Do not apply any makeup, self tanners, spray tan, sunscreen or any other facial products, ect on or around your brows for at least 3-4 weeks until healed. Do not get them wet or sweat on them for at least 3-4 weeks until healed. I agree that I have been made aware of the aftercare instructions and have read through thoroughly. I am aware that by not following the aftercare instructions carefully, that it can alter my healed results due to my own negligence. You will also be given these instructions verbally at your appointment and can ask any questions at the appointment about the aftercare. I agree I have read and agree to follow these instructions carefully.*
Yes I have read and understand/agree with the above information.
No
Microblading/powder brow Healing scheduleOne of the most common questions we're asked is what to expect during the healing process. While every person is different and some heal more quickly or slowly than others, here's generally what to expect. Temporary side effects from micropigmentation include but are not limited to: redness, swelling, puffiness, bruising, dry patches and tenderness. You should expect to lose approximately 1/3 of the initial color during the healing process. We have selected the optimal pigments for you with this in mind. The first couple of days they may get extremely dark. In approximately six days or more it may appear too light. After about 10 days, the color will show more. It will appear softer when completely healed. Day 1 The eyebrows are approximately 20- 25% bolder and darker in width than they will be when healed. Expect light to moderate swelling and redness. The skin's redness causes the color of the pigment to appear darker. There is some swelling, although difficult to actually see due to the thickness of the skin in the eyebrow area. This will subside. New skin will heal over the pigmented area and result in a softer appearance of your eyebrows. Don't be concerned that your eyebrows initially appear darker and heavier in size than you desire. This is all part of the process. Eyebrows may start to itch. The skin begins to flake, peeling from the outside edges first. Color finishes flaking off and appears softer and grayer for a few days until color clarifies. The color has lightened from its initial overly-dark appearance. For the next few days, the color may now be lighter than what the final color will be. The final color begins to stabilize and show through. The color will continue to soften as the healing process completes. I UNDERSTAND AND ACCEPT THAT FAILURE TO FOLLOW THE POST-PROCEDURE INSTRUCTIONS ABOVE MAY RESULT IN A LOSS OR DISCOLORATION OF PIGMENT RESULTING IN A NEED FOR MORE FREQUENT TOUCHUPS OR LESS THAN DESIRED RESULTS. I agree I have read through this carefully.*
Yes I am aware, agree, acknowledge and understand the above information.
No
The Client acknowledges receipt of pre-procedure information and post-procedure (aftercare) instructions from the Specialist, and agrees that they have read them, have been advised of them, understand them, and agree to adhere to them in order to help ensure satisfactory results from the procedure(s) and help prevent secondary infection. The Client acknowledges that all final adjustments and detail work will be done in the second session, and will schedule a follow-up session with the Specialist 6 weeks of the procedure(s).*
Yes I am aware, agree and acknowledge
No

By signing below this line, I acknowledge that I have thoroughly read the entirety of this form, that I understand the terms contained herein, that I agree to adhere to any and all pre and post procedure directions, and that my answers were accurate and honest.