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Consent for permanent cosmetics brows/lips/eyeliner/freckles/beauty marks/paramedical

Tint Brow Studio is obligated to perform treatment in strict compliance with all hygiene and health protection measures. 

Warranty

Tint Brow Studio accepts liability in compliance with the legal measures and regulations in the case of negligence or carelessness or intentionally or negligently caused injuries or threat to life, body, and health. Tint Brow Studio is liable for violations of the obligations specified under the Agreement. 

Disclaimer

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


Explanation

The client was informed by Tint Brow Studio about the specific risks of your service(s).

The following risks are specifically explained to the client:

  • During the treatment, despite all the staff expertise and all the precautionary measures, an injury is possible. Despite the application of the most advanced and top quality pigments, allergic reaction is possible albeit rare. The client is informed about this and they assume liability.
  • During and after the treatment temporary swelling, redness and/or aching may occur. Experience tells us that these symptoms are temporary.
  • Depending on the skin structure after the first treatment small scabs with a loss of drawn hairs may occur and color intensity may change. In the first seven days eyebrows are 40% darker and 10-15% thicker. Color i.e. color reflection depends on the natural skin pigment. The shape is determined according to the face proportions. Symmetry is determined digitally, with closed eyes because of the negative impact of facial expressions.
  • The pigment is absorbed differently due to differences in the skin quality, thus there is no warranty for the treatment success.
  • Depending on the skin structure it should be noted that change in the color intensity is possible and that one or more additional treatments will be required. 
  • The minimum or maximum duration of microblading cannot be determined with certainty, nor can the warranty be given on performed treatment.
  • The first correction is done six weeks after the treatment. For oily skin it is necessary to perform more corrections. Permanent make-up always leads to skin injury. Therefore, it is important to carefully and gently nurture your skin after the treatment to allow healing without complications. Inadequate care in healing phase of the skin can lead to poor results and Tint Brow Studio cannot be liable for it. 

In the next seven days the client is required to pay attention to the following: 

  • Keep your treatment area dry an clean.. 
  • Avoid direct contact with water. A thick crust may appear and all the pigment could fade. 
  • Do not touch the scab in any other case except while cleaning. 
  • For post-treatment use only provided liquid 3 times per day. If skin is oily or sweaty make sure you clean the skin when necessary.
  • Please do not use any other creams except the ones provided to you in order to prevent possible infections or allergic reactions.
  • In the first two weeks after the treatment avoid public bathing, sunbathing, tanning salon, sauna, beauty treatments and intense training accompanied by sweating (sports activities) contact with dust (household chores, etc.). 

Tint Brow Studio is not liable in case of improper post-treatment. 

After instructions were given to the client.


Today's date: September 10, 2024


First Participant's Name

First Name*

Middle Name

Last Name*

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

Health Condition Questionnaire 

In order to perform the your service(s) in a safe manner, please answer the following health questions accurately.

Have you possibly been exposed to anyone with COVID-19 or experienced any symptoms of COVID-19 in the last 14 days *
No
Yes
Do you have any of the following symptoms: fever, chills, cough, shortness of breath, difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion, runny nose, nausea, vomiting, or diarrhea?*
No
Yes

Do you suffer from the following disease or are you taking any of these medications? 

Hemophilia*
No
Yes
Diabetes Mellitus (diabetes) *
No
Yes
Hepatitis A, B, C, D, E, F*
No
Yes
HIV +*
No
Yes
Skin diseases*
No
Yes
Eczema*
No
Yes
Allergies*
No
Yes

Please elaborate below if yes:
Autoimmune diseases*
No
Yes
Are you prone to herpes?*
No
Yes
Infection diseases / high fever *
No
Yes
Epilepsy*
No
Yes
Are you taking medication for blood thinning?*
No
Yes

Please elaborate below if yes:
Are you pregnant?*
No
Yes
Are you taking any medications on a daily basis? *
No
Yes

Please elaborate below if yes:
Have you had any laser treatments, peels, microderm, microneedling, nanoneedle, or any other facial treatment in the last 14 days.*
No
Yes

Please elaborate below if yes:

What skin care products do you use daily?

Retinol*
No
Yes
Acids*
No
Yes
Anti-Aging*
No
Yes
Acutane*
No
Yes
Peels*
No
Yes

Please elaborate below:
Do you have a pacemaker?*
No
Yes
Do you have problems with healing of wounds?*
No
Yes
Have you consumed drugs or alcohol in the last 24 hours? *
No
Yes
Did you undergo surgery in the last 14 days, and/or were you exposed to radiation or had any other medical interventions? *
No
Yes
Do you have any other health problems or conditions?*
No
Yes

Please elaborate below if yes:
Are you under a care of a physician?*
No
Yes

Please elaborate below if yes:

Physician’s name:

This information is confidential and it shall also be handled that way.

Tint Brow Studio assumes no liability in case of giving false information.

Contractual Obligations

I agree to have my photo taken and for those photos to use used for advertising purposes. *
Yes
No
I agree to have my photo taken for insurance and documentation purposes. We REQUIRE this. *
Yes
No

Disclaimer

There is a possibility of an allergic reaction to pigments. A patch test is advisable however it does not ensure a client will not have an allergic reaction. If you would like the patch test, we will test a small area and then you will come back on a different day to complete your full appointment. 


Patch Test Consent:
I waive the patch test
I would like a patch test

If waived, I release the technician from liability if I develop an allergic reaction to the pigment. 

Explanation

I confirm that I have read and understood the above mentioned information. *
Yes
No
I received a clear and understandable response to all my questions. *
Yes
No
The treatment procedure and post-treatment care was explained to me in detail and I agree to it.*
Yes
No
I do not have any further questions. After care instructions were given to the client.*
Yes
No
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

Health Condition Questionnaire 

In order to perform the your service(s) in a safe manner, please answer the following health questions accurately.

Have you possibly been exposed to anyone with COVID-19 or experienced any symptoms of COVID-19 in the last 14 days *
No
Yes
Do you have any of the following symptoms: fever, chills, cough, shortness of breath, difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion, runny nose, nausea, vomiting, or diarrhea?*
No
Yes

Do you suffer from the following disease or are you taking any of these medications? 

Hemophilia*
No
Yes
Diabetes Mellitus (diabetes) *
No
Yes
Hepatitis A, B, C, D, E, F*
No
Yes
HIV +*
No
Yes
Skin diseases*
No
Yes
Eczema*
No
Yes
Allergies*
No
Yes

Please elaborate below if yes:
Autoimmune diseases*
No
Yes
Are you prone to herpes?*
No
Yes
Infection diseases / high fever *
No
Yes
Epilepsy*
No
Yes
Are you taking medication for blood thinning?*
No
Yes

Please elaborate below if yes:
Are you pregnant?*
No
Yes
Are you taking any medications on a daily basis? *
No
Yes

Please elaborate below if yes:
Have you had any laser treatments, peels, microderm, microneedling, nanoneedle, or any other facial treatment in the last 14 days.*
No
Yes

Please elaborate below if yes:

What skin care products do you use daily?

Retinol*
No
Yes
Acids*
No
Yes
Anti-Aging*
No
Yes
Acutane*
No
Yes
Peels*
No
Yes

Please elaborate below:
Do you have a pacemaker?*
No
Yes
Do you have problems with healing of wounds?*
No
Yes
Have you consumed drugs or alcohol in the last 24 hours? *
No
Yes
Did you undergo surgery in the last 14 days, and/or were you exposed to radiation or had any other medical interventions? *
No
Yes
Do you have any other health problems or conditions?*
No
Yes

Please elaborate below if yes:
Are you under a care of a physician?*
No
Yes

Please elaborate below if yes:

Physician’s name:

This information is confidential and it shall also be handled that way.

Tint Brow Studio assumes no liability in case of giving false information.

Contractual Obligations

I agree to have my photo taken and for those photos to use used for advertising purposes. *
Yes
No
I agree to have my photo taken for insurance and documentation purposes. We REQUIRE this. *
Yes
No

Disclaimer

There is a possibility of an allergic reaction to pigments. A patch test is advisable however it does not ensure a client will not have an allergic reaction. If you would like the patch test, we will test a small area and then you will come back on a different day to complete your full appointment. 


Patch Test Consent:
I waive the patch test
I would like a patch test

If waived, I release the technician from liability if I develop an allergic reaction to the pigment. 

Explanation

I confirm that I have read and understood the above mentioned information. *
Yes
No
I received a clear and understandable response to all my questions. *
Yes
No
The treatment procedure and post-treatment care was explained to me in detail and I agree to it.*
Yes
No
I do not have any further questions. After care instructions were given to the client.*
Yes
No
Third Participant's Name

First Name*

Middle Name

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

Health Condition Questionnaire 

In order to perform the your service(s) in a safe manner, please answer the following health questions accurately.

Have you possibly been exposed to anyone with COVID-19 or experienced any symptoms of COVID-19 in the last 14 days *
No
Yes
Do you have any of the following symptoms: fever, chills, cough, shortness of breath, difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion, runny nose, nausea, vomiting, or diarrhea?*
No
Yes

Do you suffer from the following disease or are you taking any of these medications? 

Hemophilia*
No
Yes
Diabetes Mellitus (diabetes) *
No
Yes
Hepatitis A, B, C, D, E, F*
No
Yes
HIV +*
No
Yes
Skin diseases*
No
Yes
Eczema*
No
Yes
Allergies*
No
Yes

Please elaborate below if yes:
Autoimmune diseases*
No
Yes
Are you prone to herpes?*
No
Yes
Infection diseases / high fever *
No
Yes
Epilepsy*
No
Yes
Are you taking medication for blood thinning?*
No
Yes

Please elaborate below if yes:
Are you pregnant?*
No
Yes
Are you taking any medications on a daily basis? *
No
Yes

Please elaborate below if yes:
Have you had any laser treatments, peels, microderm, microneedling, nanoneedle, or any other facial treatment in the last 14 days.*
No
Yes

Please elaborate below if yes:

What skin care products do you use daily?

Retinol*
No
Yes
Acids*
No
Yes
Anti-Aging*
No
Yes
Acutane*
No
Yes
Peels*
No
Yes

Please elaborate below:
Do you have a pacemaker?*
No
Yes
Do you have problems with healing of wounds?*
No
Yes
Have you consumed drugs or alcohol in the last 24 hours? *
No
Yes
Did you undergo surgery in the last 14 days, and/or were you exposed to radiation or had any other medical interventions? *
No
Yes
Do you have any other health problems or conditions?*
No
Yes

Please elaborate below if yes:
Are you under a care of a physician?*
No
Yes

Please elaborate below if yes:

Physician’s name:

This information is confidential and it shall also be handled that way.

Tint Brow Studio assumes no liability in case of giving false information.

Contractual Obligations

I agree to have my photo taken and for those photos to use used for advertising purposes. *
Yes
No
I agree to have my photo taken for insurance and documentation purposes. We REQUIRE this. *
Yes
No

Disclaimer

There is a possibility of an allergic reaction to pigments. A patch test is advisable however it does not ensure a client will not have an allergic reaction. If you would like the patch test, we will test a small area and then you will come back on a different day to complete your full appointment. 


Patch Test Consent:
I waive the patch test
I would like a patch test

If waived, I release the technician from liability if I develop an allergic reaction to the pigment. 

Explanation

I confirm that I have read and understood the above mentioned information. *
Yes
No
I received a clear and understandable response to all my questions. *
Yes
No
The treatment procedure and post-treatment care was explained to me in detail and I agree to it.*
Yes
No
I do not have any further questions. After care instructions were given to the client.*
Yes
No
Fourth Participant's Name

First Name*

Middle Name

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

Health Condition Questionnaire 

In order to perform the your service(s) in a safe manner, please answer the following health questions accurately.

Have you possibly been exposed to anyone with COVID-19 or experienced any symptoms of COVID-19 in the last 14 days *
No
Yes
Do you have any of the following symptoms: fever, chills, cough, shortness of breath, difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion, runny nose, nausea, vomiting, or diarrhea?*
No
Yes

Do you suffer from the following disease or are you taking any of these medications? 

Hemophilia*
No
Yes
Diabetes Mellitus (diabetes) *
No
Yes
Hepatitis A, B, C, D, E, F*
No
Yes
HIV +*
No
Yes
Skin diseases*
No
Yes
Eczema*
No
Yes
Allergies*
No
Yes

Please elaborate below if yes:
Autoimmune diseases*
No
Yes
Are you prone to herpes?*
No
Yes
Infection diseases / high fever *
No
Yes
Epilepsy*
No
Yes
Are you taking medication for blood thinning?*
No
Yes

Please elaborate below if yes:
Are you pregnant?*
No
Yes
Are you taking any medications on a daily basis? *
No
Yes

Please elaborate below if yes:
Have you had any laser treatments, peels, microderm, microneedling, nanoneedle, or any other facial treatment in the last 14 days.*
No
Yes

Please elaborate below if yes:

What skin care products do you use daily?

Retinol*
No
Yes
Acids*
No
Yes
Anti-Aging*
No
Yes
Acutane*
No
Yes
Peels*
No
Yes

Please elaborate below:
Do you have a pacemaker?*
No
Yes
Do you have problems with healing of wounds?*
No
Yes
Have you consumed drugs or alcohol in the last 24 hours? *
No
Yes
Did you undergo surgery in the last 14 days, and/or were you exposed to radiation or had any other medical interventions? *
No
Yes
Do you have any other health problems or conditions?*
No
Yes

Please elaborate below if yes:
Are you under a care of a physician?*
No
Yes

Please elaborate below if yes:

Physician’s name:

This information is confidential and it shall also be handled that way.

Tint Brow Studio assumes no liability in case of giving false information.

Contractual Obligations

I agree to have my photo taken and for those photos to use used for advertising purposes. *
Yes
No
I agree to have my photo taken for insurance and documentation purposes. We REQUIRE this. *
Yes
No

Disclaimer

There is a possibility of an allergic reaction to pigments. A patch test is advisable however it does not ensure a client will not have an allergic reaction. If you would like the patch test, we will test a small area and then you will come back on a different day to complete your full appointment. 


Patch Test Consent:
I waive the patch test
I would like a patch test

If waived, I release the technician from liability if I develop an allergic reaction to the pigment. 

Explanation

I confirm that I have read and understood the above mentioned information. *
Yes
No
I received a clear and understandable response to all my questions. *
Yes
No
The treatment procedure and post-treatment care was explained to me in detail and I agree to it.*
Yes
No
I do not have any further questions. After care instructions were given to the client.*
Yes
No
Fifth Participant's Name

First Name*

Middle Name

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

Health Condition Questionnaire 

In order to perform the your service(s) in a safe manner, please answer the following health questions accurately.

Have you possibly been exposed to anyone with COVID-19 or experienced any symptoms of COVID-19 in the last 14 days *
No
Yes
Do you have any of the following symptoms: fever, chills, cough, shortness of breath, difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion, runny nose, nausea, vomiting, or diarrhea?*
No
Yes

Do you suffer from the following disease or are you taking any of these medications? 

Hemophilia*
No
Yes
Diabetes Mellitus (diabetes) *
No
Yes
Hepatitis A, B, C, D, E, F*
No
Yes
HIV +*
No
Yes
Skin diseases*
No
Yes
Eczema*
No
Yes
Allergies*
No
Yes

Please elaborate below if yes:
Autoimmune diseases*
No
Yes
Are you prone to herpes?*
No
Yes
Infection diseases / high fever *
No
Yes
Epilepsy*
No
Yes
Are you taking medication for blood thinning?*
No
Yes

Please elaborate below if yes:
Are you pregnant?*
No
Yes
Are you taking any medications on a daily basis? *
No
Yes

Please elaborate below if yes:
Have you had any laser treatments, peels, microderm, microneedling, nanoneedle, or any other facial treatment in the last 14 days.*
No
Yes

Please elaborate below if yes:

What skin care products do you use daily?

Retinol*
No
Yes
Acids*
No
Yes
Anti-Aging*
No
Yes
Acutane*
No
Yes
Peels*
No
Yes

Please elaborate below:
Do you have a pacemaker?*
No
Yes
Do you have problems with healing of wounds?*
No
Yes
Have you consumed drugs or alcohol in the last 24 hours? *
No
Yes
Did you undergo surgery in the last 14 days, and/or were you exposed to radiation or had any other medical interventions? *
No
Yes
Do you have any other health problems or conditions?*
No
Yes

Please elaborate below if yes:
Are you under a care of a physician?*
No
Yes

Please elaborate below if yes:

Physician’s name:

This information is confidential and it shall also be handled that way.

Tint Brow Studio assumes no liability in case of giving false information.

Contractual Obligations

I agree to have my photo taken and for those photos to use used for advertising purposes. *
Yes
No
I agree to have my photo taken for insurance and documentation purposes. We REQUIRE this. *
Yes
No

Disclaimer

There is a possibility of an allergic reaction to pigments. A patch test is advisable however it does not ensure a client will not have an allergic reaction. If you would like the patch test, we will test a small area and then you will come back on a different day to complete your full appointment. 


Patch Test Consent:
I waive the patch test
I would like a patch test

If waived, I release the technician from liability if I develop an allergic reaction to the pigment. 

Explanation

I confirm that I have read and understood the above mentioned information. *
Yes
No
I received a clear and understandable response to all my questions. *
Yes
No
The treatment procedure and post-treatment care was explained to me in detail and I agree to it.*
Yes
No
I do not have any further questions. After care instructions were given to the client.*
Yes
No
Sixth Participant's Name

First Name*

Middle Name

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

Health Condition Questionnaire 

In order to perform the your service(s) in a safe manner, please answer the following health questions accurately.

Have you possibly been exposed to anyone with COVID-19 or experienced any symptoms of COVID-19 in the last 14 days *
No
Yes
Do you have any of the following symptoms: fever, chills, cough, shortness of breath, difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion, runny nose, nausea, vomiting, or diarrhea?*
No
Yes

Do you suffer from the following disease or are you taking any of these medications? 

Hemophilia*
No
Yes
Diabetes Mellitus (diabetes) *
No
Yes
Hepatitis A, B, C, D, E, F*
No
Yes
HIV +*
No
Yes
Skin diseases*
No
Yes
Eczema*
No
Yes
Allergies*
No
Yes

Please elaborate below if yes:
Autoimmune diseases*
No
Yes
Are you prone to herpes?*
No
Yes
Infection diseases / high fever *
No
Yes
Epilepsy*
No
Yes
Are you taking medication for blood thinning?*
No
Yes

Please elaborate below if yes:
Are you pregnant?*
No
Yes
Are you taking any medications on a daily basis? *
No
Yes

Please elaborate below if yes:
Have you had any laser treatments, peels, microderm, microneedling, nanoneedle, or any other facial treatment in the last 14 days.*
No
Yes

Please elaborate below if yes:

What skin care products do you use daily?

Retinol*
No
Yes
Acids*
No
Yes
Anti-Aging*
No
Yes
Acutane*
No
Yes
Peels*
No
Yes

Please elaborate below:
Do you have a pacemaker?*
No
Yes
Do you have problems with healing of wounds?*
No
Yes
Have you consumed drugs or alcohol in the last 24 hours? *
No
Yes
Did you undergo surgery in the last 14 days, and/or were you exposed to radiation or had any other medical interventions? *
No
Yes
Do you have any other health problems or conditions?*
No
Yes

Please elaborate below if yes:
Are you under a care of a physician?*
No
Yes

Please elaborate below if yes:

Physician’s name:

This information is confidential and it shall also be handled that way.

Tint Brow Studio assumes no liability in case of giving false information.

Contractual Obligations

I agree to have my photo taken and for those photos to use used for advertising purposes. *
Yes
No
I agree to have my photo taken for insurance and documentation purposes. We REQUIRE this. *
Yes
No

Disclaimer

There is a possibility of an allergic reaction to pigments. A patch test is advisable however it does not ensure a client will not have an allergic reaction. If you would like the patch test, we will test a small area and then you will come back on a different day to complete your full appointment. 


Patch Test Consent:
I waive the patch test
I would like a patch test

If waived, I release the technician from liability if I develop an allergic reaction to the pigment. 

Explanation

I confirm that I have read and understood the above mentioned information. *
Yes
No
I received a clear and understandable response to all my questions. *
Yes
No
The treatment procedure and post-treatment care was explained to me in detail and I agree to it.*
Yes
No
I do not have any further questions. After care instructions were given to the client.*
Yes
No
Seventh Participant's Name

First Name*

Middle Name

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

Health Condition Questionnaire 

In order to perform the your service(s) in a safe manner, please answer the following health questions accurately.

Have you possibly been exposed to anyone with COVID-19 or experienced any symptoms of COVID-19 in the last 14 days *
No
Yes
Do you have any of the following symptoms: fever, chills, cough, shortness of breath, difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion, runny nose, nausea, vomiting, or diarrhea?*
No
Yes

Do you suffer from the following disease or are you taking any of these medications? 

Hemophilia*
No
Yes
Diabetes Mellitus (diabetes) *
No
Yes
Hepatitis A, B, C, D, E, F*
No
Yes
HIV +*
No
Yes
Skin diseases*
No
Yes
Eczema*
No
Yes
Allergies*
No
Yes

Please elaborate below if yes:
Autoimmune diseases*
No
Yes
Are you prone to herpes?*
No
Yes
Infection diseases / high fever *
No
Yes
Epilepsy*
No
Yes
Are you taking medication for blood thinning?*
No
Yes

Please elaborate below if yes:
Are you pregnant?*
No
Yes
Are you taking any medications on a daily basis? *
No
Yes

Please elaborate below if yes:
Have you had any laser treatments, peels, microderm, microneedling, nanoneedle, or any other facial treatment in the last 14 days.*
No
Yes

Please elaborate below if yes:

What skin care products do you use daily?

Retinol*
No
Yes
Acids*
No
Yes
Anti-Aging*
No
Yes
Acutane*
No
Yes
Peels*
No
Yes

Please elaborate below:
Do you have a pacemaker?*
No
Yes
Do you have problems with healing of wounds?*
No
Yes
Have you consumed drugs or alcohol in the last 24 hours? *
No
Yes
Did you undergo surgery in the last 14 days, and/or were you exposed to radiation or had any other medical interventions? *
No
Yes
Do you have any other health problems or conditions?*
No
Yes

Please elaborate below if yes:
Are you under a care of a physician?*
No
Yes

Please elaborate below if yes:

Physician’s name:

This information is confidential and it shall also be handled that way.

Tint Brow Studio assumes no liability in case of giving false information.

Contractual Obligations

I agree to have my photo taken and for those photos to use used for advertising purposes. *
Yes
No
I agree to have my photo taken for insurance and documentation purposes. We REQUIRE this. *
Yes
No

Disclaimer

There is a possibility of an allergic reaction to pigments. A patch test is advisable however it does not ensure a client will not have an allergic reaction. If you would like the patch test, we will test a small area and then you will come back on a different day to complete your full appointment. 


Patch Test Consent:
I waive the patch test
I would like a patch test

If waived, I release the technician from liability if I develop an allergic reaction to the pigment. 

Explanation

I confirm that I have read and understood the above mentioned information. *
Yes
No
I received a clear and understandable response to all my questions. *
Yes
No
The treatment procedure and post-treatment care was explained to me in detail and I agree to it.*
Yes
No
I do not have any further questions. After care instructions were given to the client.*
Yes
No
Eighth Participant's Name

First Name*

Middle Name

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

Health Condition Questionnaire 

In order to perform the your service(s) in a safe manner, please answer the following health questions accurately.

Have you possibly been exposed to anyone with COVID-19 or experienced any symptoms of COVID-19 in the last 14 days *
No
Yes
Do you have any of the following symptoms: fever, chills, cough, shortness of breath, difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion, runny nose, nausea, vomiting, or diarrhea?*
No
Yes

Do you suffer from the following disease or are you taking any of these medications? 

Hemophilia*
No
Yes
Diabetes Mellitus (diabetes) *
No
Yes
Hepatitis A, B, C, D, E, F*
No
Yes
HIV +*
No
Yes
Skin diseases*
No
Yes
Eczema*
No
Yes
Allergies*
No
Yes

Please elaborate below if yes:
Autoimmune diseases*
No
Yes
Are you prone to herpes?*
No
Yes
Infection diseases / high fever *
No
Yes
Epilepsy*
No
Yes
Are you taking medication for blood thinning?*
No
Yes

Please elaborate below if yes:
Are you pregnant?*
No
Yes
Are you taking any medications on a daily basis? *
No
Yes

Please elaborate below if yes:
Have you had any laser treatments, peels, microderm, microneedling, nanoneedle, or any other facial treatment in the last 14 days.*
No
Yes

Please elaborate below if yes:

What skin care products do you use daily?

Retinol*
No
Yes
Acids*
No
Yes
Anti-Aging*
No
Yes
Acutane*
No
Yes
Peels*
No
Yes

Please elaborate below:
Do you have a pacemaker?*
No
Yes
Do you have problems with healing of wounds?*
No
Yes
Have you consumed drugs or alcohol in the last 24 hours? *
No
Yes
Did you undergo surgery in the last 14 days, and/or were you exposed to radiation or had any other medical interventions? *
No
Yes
Do you have any other health problems or conditions?*
No
Yes

Please elaborate below if yes:
Are you under a care of a physician?*
No
Yes

Please elaborate below if yes:

Physician’s name:

This information is confidential and it shall also be handled that way.

Tint Brow Studio assumes no liability in case of giving false information.

Contractual Obligations

I agree to have my photo taken and for those photos to use used for advertising purposes. *
Yes
No
I agree to have my photo taken for insurance and documentation purposes. We REQUIRE this. *
Yes
No

Disclaimer

There is a possibility of an allergic reaction to pigments. A patch test is advisable however it does not ensure a client will not have an allergic reaction. If you would like the patch test, we will test a small area and then you will come back on a different day to complete your full appointment. 


Patch Test Consent:
I waive the patch test
I would like a patch test

If waived, I release the technician from liability if I develop an allergic reaction to the pigment. 

Explanation

I confirm that I have read and understood the above mentioned information. *
Yes
No
I received a clear and understandable response to all my questions. *
Yes
No
The treatment procedure and post-treatment care was explained to me in detail and I agree to it.*
Yes
No
I do not have any further questions. After care instructions were given to the client.*
Yes
No
Ninth Participant's Name

First Name*

Middle Name

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

Health Condition Questionnaire 

In order to perform the your service(s) in a safe manner, please answer the following health questions accurately.

Have you possibly been exposed to anyone with COVID-19 or experienced any symptoms of COVID-19 in the last 14 days *
No
Yes
Do you have any of the following symptoms: fever, chills, cough, shortness of breath, difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion, runny nose, nausea, vomiting, or diarrhea?*
No
Yes

Do you suffer from the following disease or are you taking any of these medications? 

Hemophilia*
No
Yes
Diabetes Mellitus (diabetes) *
No
Yes
Hepatitis A, B, C, D, E, F*
No
Yes
HIV +*
No
Yes
Skin diseases*
No
Yes
Eczema*
No
Yes
Allergies*
No
Yes

Please elaborate below if yes:
Autoimmune diseases*
No
Yes
Are you prone to herpes?*
No
Yes
Infection diseases / high fever *
No
Yes
Epilepsy*
No
Yes
Are you taking medication for blood thinning?*
No
Yes

Please elaborate below if yes:
Are you pregnant?*
No
Yes
Are you taking any medications on a daily basis? *
No
Yes

Please elaborate below if yes:
Have you had any laser treatments, peels, microderm, microneedling, nanoneedle, or any other facial treatment in the last 14 days.*
No
Yes

Please elaborate below if yes:

What skin care products do you use daily?

Retinol*
No
Yes
Acids*
No
Yes
Anti-Aging*
No
Yes
Acutane*
No
Yes
Peels*
No
Yes

Please elaborate below:
Do you have a pacemaker?*
No
Yes
Do you have problems with healing of wounds?*
No
Yes
Have you consumed drugs or alcohol in the last 24 hours? *
No
Yes
Did you undergo surgery in the last 14 days, and/or were you exposed to radiation or had any other medical interventions? *
No
Yes
Do you have any other health problems or conditions?*
No
Yes

Please elaborate below if yes:
Are you under a care of a physician?*
No
Yes

Please elaborate below if yes:

Physician’s name:

This information is confidential and it shall also be handled that way.

Tint Brow Studio assumes no liability in case of giving false information.

Contractual Obligations

I agree to have my photo taken and for those photos to use used for advertising purposes. *
Yes
No
I agree to have my photo taken for insurance and documentation purposes. We REQUIRE this. *
Yes
No

Disclaimer

There is a possibility of an allergic reaction to pigments. A patch test is advisable however it does not ensure a client will not have an allergic reaction. If you would like the patch test, we will test a small area and then you will come back on a different day to complete your full appointment. 


Patch Test Consent:
I waive the patch test
I would like a patch test

If waived, I release the technician from liability if I develop an allergic reaction to the pigment. 

Explanation

I confirm that I have read and understood the above mentioned information. *
Yes
No
I received a clear and understandable response to all my questions. *
Yes
No
The treatment procedure and post-treatment care was explained to me in detail and I agree to it.*
Yes
No
I do not have any further questions. After care instructions were given to the client.*
Yes
No
Tenth Participant's Name

First Name*

Middle Name

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

Health Condition Questionnaire 

In order to perform the your service(s) in a safe manner, please answer the following health questions accurately.

Have you possibly been exposed to anyone with COVID-19 or experienced any symptoms of COVID-19 in the last 14 days *
No
Yes
Do you have any of the following symptoms: fever, chills, cough, shortness of breath, difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion, runny nose, nausea, vomiting, or diarrhea?*
No
Yes

Do you suffer from the following disease or are you taking any of these medications? 

Hemophilia*
No
Yes
Diabetes Mellitus (diabetes) *
No
Yes
Hepatitis A, B, C, D, E, F*
No
Yes
HIV +*
No
Yes
Skin diseases*
No
Yes
Eczema*
No
Yes
Allergies*
No
Yes

Please elaborate below if yes:
Autoimmune diseases*
No
Yes
Are you prone to herpes?*
No
Yes
Infection diseases / high fever *
No
Yes
Epilepsy*
No
Yes
Are you taking medication for blood thinning?*
No
Yes

Please elaborate below if yes:
Are you pregnant?*
No
Yes
Are you taking any medications on a daily basis? *
No
Yes

Please elaborate below if yes:
Have you had any laser treatments, peels, microderm, microneedling, nanoneedle, or any other facial treatment in the last 14 days.*
No
Yes

Please elaborate below if yes:

What skin care products do you use daily?

Retinol*
No
Yes
Acids*
No
Yes
Anti-Aging*
No
Yes
Acutane*
No
Yes
Peels*
No
Yes

Please elaborate below:
Do you have a pacemaker?*
No
Yes
Do you have problems with healing of wounds?*
No
Yes
Have you consumed drugs or alcohol in the last 24 hours? *
No
Yes
Did you undergo surgery in the last 14 days, and/or were you exposed to radiation or had any other medical interventions? *
No
Yes
Do you have any other health problems or conditions?*
No
Yes

Please elaborate below if yes:
Are you under a care of a physician?*
No
Yes

Please elaborate below if yes:

Physician’s name:

This information is confidential and it shall also be handled that way.

Tint Brow Studio assumes no liability in case of giving false information.

Contractual Obligations

I agree to have my photo taken and for those photos to use used for advertising purposes. *
Yes
No
I agree to have my photo taken for insurance and documentation purposes. We REQUIRE this. *
Yes
No

Disclaimer

There is a possibility of an allergic reaction to pigments. A patch test is advisable however it does not ensure a client will not have an allergic reaction. If you would like the patch test, we will test a small area and then you will come back on a different day to complete your full appointment. 


Patch Test Consent:
I waive the patch test
I would like a patch test

If waived, I release the technician from liability if I develop an allergic reaction to the pigment. 

Explanation

I confirm that I have read and understood the above mentioned information. *
Yes
No
I received a clear and understandable response to all my questions. *
Yes
No
The treatment procedure and post-treatment care was explained to me in detail and I agree to it.*
Yes
No
I do not have any further questions. After care instructions were given to the client.*
Yes
No
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Health Condition Questionnaire 

In order to perform the your service(s) in a safe manner, please answer the following health questions accurately.

Have you possibly been exposed to anyone with COVID-19 or experienced any symptoms of COVID-19 in the last 14 days *
No
Yes
Do you have any of the following symptoms: fever, chills, cough, shortness of breath, difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion, runny nose, nausea, vomiting, or diarrhea?*
No
Yes

Do you suffer from the following disease or are you taking any of these medications? 

Hemophilia*
No
Yes
Diabetes Mellitus (diabetes) *
No
Yes
Hepatitis A, B, C, D, E, F*
No
Yes
HIV +*
No
Yes
Skin diseases*
No
Yes
Eczema*
No
Yes
Allergies*
No
Yes

Please elaborate below if yes:
Autoimmune diseases*
No
Yes
Are you prone to herpes?*
No
Yes
Infection diseases / high fever *
No
Yes
Epilepsy*
No
Yes
Are you taking medication for blood thinning?*
No
Yes

Please elaborate below if yes:
Are you pregnant?*
No
Yes
Are you taking any medications on a daily basis? *
No
Yes

Please elaborate below if yes:
Have you had any laser treatments, peels, microderm, microneedling, nanoneedle, or any other facial treatment in the last 14 days.*
No
Yes

Please elaborate below if yes:

What skin care products do you use daily?

Retinol*
No
Yes
Acids*
No
Yes
Anti-Aging*
No
Yes
Acutane*
No
Yes
Peels*
No
Yes

Please elaborate below:
Do you have a pacemaker?*
No
Yes
Do you have problems with healing of wounds?*
No
Yes
Have you consumed drugs or alcohol in the last 24 hours? *
No
Yes
Did you undergo surgery in the last 14 days, and/or were you exposed to radiation or had any other medical interventions? *
No
Yes
Do you have any other health problems or conditions?*
No
Yes

Please elaborate below if yes:
Are you under a care of a physician?*
No
Yes

Please elaborate below if yes:

Physician’s name:

This information is confidential and it shall also be handled that way.

Tint Brow Studio assumes no liability in case of giving false information.

Contractual Obligations

I agree to have my photo taken and for those photos to use used for advertising purposes. *
Yes
No
I agree to have my photo taken for insurance and documentation purposes. We REQUIRE this. *
Yes
No

Disclaimer

There is a possibility of an allergic reaction to pigments. A patch test is advisable however it does not ensure a client will not have an allergic reaction. If you would like the patch test, we will test a small area and then you will come back on a different day to complete your full appointment. 


Patch Test Consent:
I waive the patch test
I would like a patch test

If waived, I release the technician from liability if I develop an allergic reaction to the pigment. 

Explanation

I confirm that I have read and understood the above mentioned information. *
Yes
No
I received a clear and understandable response to all my questions. *
Yes
No
The treatment procedure and post-treatment care was explained to me in detail and I agree to it.*
Yes
No
I do not have any further questions. After care instructions were given to the client.*
Yes
No
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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