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Please read through this document thoroughly.

This document outlines and confirms your understanding our safety and health protocols for all permanent makeup services offered at Evesbrows and includes informaton regarding:

• Contraindications

• Possible Risks, Hazards or Complications

• Possible Infections

• Care & Maintenance 

• Policies

• Consent & Release Agreement

• Health Condition Questionnaire




CONTRAINDICATIONS

In medicine, a contraindication (of a condition or circumstance such as a major or minor health condition) suggests or indicate that (a particular technique or drug should not be used in the case in question.

I have been made aware that if I do have a pre-existing condition that has been approved by a Evesbrows employee

that results can be impacted in shape, color and retainment. I also know I may be asked at any given time to provide a clearance note from my doctor for health conditions similar to the following:


POSSIBLE RISKS + HAZARDS / COMPLICATIONS

On average, permanent makeup appointments can last between 2 1/2 - 3 hours+ depending on the service however, We CANNOT guarantee this for all clients. It’s important that you understand that satisfactory results of this procedure depend 50% on the artist, and 50% is up to your skin and how you care for your tattoo after you leave our studio.

** Allergic reaction – Allergic reactions can occur from any anesthetics used during the procedure. If you do suffer from an allergic reaction, you should contact your doctor immediately. Allergic reaction response may show through redness, swelling, rash, blistering, dryness or any other symptoms associated with an allergic reaction. You may take a 5-7 day patch test to determine this.

** Pain & Numbness – We cannot accept responsibility if the area to be treated does not respond to the numbing cream. Each individual is different according to skin type. Some clients report the area to be completely numb, while others may experience some discomfort.

Evesbrows does offer numbing cream/gel for most permanent makeup procedures at some point in the session. The products are formulated to be perfectly safe. As a result of the treatment, combined with the use of the anesthetic, you can expect to experience some redness/swelling that can last couple hours. You should always follow your post procedure advice and after care for the best results.

** Uneven pigmentation: This can result from poor healing, infection, bleeding or many other causes. Your follow up appointment will likely correct any uneven appearances.

** Asymmetry: Every efforts will be made to avoid asymmetry but our faces are not symmetrical so adjustments may be needed during the follow up session to correct any unevenness

** MRI: Because pigments used in Permanent Cosmetic procedures contain inert oxides, a low level magnet may be required if you need to be scanned by an MRI machine. You must inform your MRI Technician of any tattoos or permanent cosmetics.

POSSIBLE INFECTIONS

Although it's important to note that infections during the a cosmetic tattooing process are VERY RARE (about 1-3% or 1-3 in 100 people), it's important to understand what risks it can include and how to treat it if your suspect it.

All instruments that enter the skin or come in contact with body fluids are disposable, and disposed of after use. Cross contamination guidelines are strictly adhered to. If at any point the area treated becomes red, itchy, oozing, overly inflamed these are possible signs of infection, you must contact a doctor or go to the nearest medical facility immediately.

It is highly crucial that you follow the aftercare process to a T as there can be a small risk (around 1-3%) that you may experience an infection if not taken with proper care. In mild cases, infections can be treated with over the counter antibiotics that can be topically placed on your skin. In extream, serious cases, you may need to see a doctor and recieve a perscibed antibotic that you cannont recieve over the counter. The biggest risk in developing a deep infection to the skin can turn into a condition known as "Cellulitis". Cellulities is an infection of the inner layer of the skin that can spread if not treated appropriately. Other conditons such as Nickel reactions and rashes can occur if the client is allergic to the pigment that is placed on their skin. (Please note, Evesbrows Pigments are water based and do not include Nickel but this is important to know in case you ever decide to recieve microblading services from another establishment.)If you suspect that you have an infection, please contact a Evesbrows speciliast immediately.

Early stage infection systems:

• Odor comming from your eyebrow

• Discharge that may be a greenish/brown color

• Redness around the procedure area but not extending beyond it

• Tenderness when touch *With the exception of your aftercare products, please avoid touching the treated area after the procedure!

Most of these symptoms can be treated as long as you catch it early. Please consult a medical professional to see if you should consider these tips if you have an early infection:

• Consider using an antibiotic ointment like Bacitracin. Bacitracin will treat the most common skin pathogens such as staph and strep (even MRSA) and does not include ointments that can irritate the skin.

• Avoid using triple antibiotic ointment like neosporin which contains neomycin that approximately 1 in 10 people react to with a rash (that's a LOT of people).

• Avoid covering up the treated area with creams and gels such as Vaseline or other emollients which can trap in heat and keep an infection in the wound (remember bacteria dies in the presence of oxygen)

• Keep the area clean! Avoid using makeup or other topical agents (besides the antibiotic) on your skin/wound

If the infection continues to develop and you begin to experience; extreme swelling/tenderness/pain or fever/chills (signs suggest you have a systemic infection) please contact your doctor ASAP. These are early signs that you may be developing facial cellulitis and may need oral or IV antibotics.

CARE & MAINTENANCE

Aftercare is a crucial element to follow to ensure proper healing and color retention. Results vary for all individuals and we cannot guarantee your results.Please do not use other products or follow other artist’s aftercare instructions during your healing process.

Please follow the aftercare directed for the appropriate service. This information can be found on our website and will also be given to you by your artist.

I agree to follow the care and maintenance instructions provided by the Artist for the care of the Procedure area following the Procedure, and that if any follow up care is required due to my own mistake or negligence, or failure to follow these instructions, this will be at my own expense and risk. I understand that failure to follow aftercare instructions may result in permanent damage to my skin, scarring and may prevent the pigment from settling. I agree to keep the procedure area clean and to follow aftercare instructions. This includes exercising, tanning, and skincare products. *

I Agree

POLICIES

I understand that there is NON -refundable, but transferable, deposit to hold my appointment. This amount will go towards the remaining amount due before the time of my appointment. This amount will change depending on the service.

I understand that Evesbrows will assess a late fee charge of $50.00 if I am more than 15 minutes late to my appointment. If I arrive more than 30 minutes late, I will forfeit my appointment and will need to reschedule at a later time.  

I understand that Evesbrows has the right to forfeit my appointment at any given time if I fail to adhere to their policies or any part of the permanent makeup treatment process.

We kindly request a notice of cancellation at least 72 hours prior to your scheduled appointment. Cancellations made after this window will result in a charge of 50% of the service cost scheduled for that day. If you need to reschedule, please notify us promptly by texting Evesbrows at 267-939-5022. (Only 1 reschedule is allowed)

Please note that any no-show appointments will result in a charge of 50% of the scheduled service cost for that day. We appreciate your cooperation and understanding in helping us maintain our schedule and serve our clients to the best of our ability.

October 2, 2024

CONSENT & RELEASE AGREEMENT

I am over the age of 18, am not under the influence of drugs or alcohol, I am not pregnant or nursing and desire to receive the indicated semi-permanent pigmentation procedure. The general nature of cosmetic micro-pigmentation, as well as the specific procedure performed has been explained to me. Furthermore, I consent to the following:


I authorize my technician to use his/her professional judgment to decide what he/she feels is necessary under the given circumstances that any unforeseen conditions arise during the course of my procedure.


I fully understand this is a tattoo process and therefore not an exact science but an art.


I accept the responsibility for determining the color, shape and position of the micro blading procedure as agreed during consultation.


I understand the actual color of the pigment may be modified slightly, due to the tone and color of my skin.

I fully understand and accept that non-toxic pigments are used during the procedure and that the result achieved may fade over a period of 1-3 years. Even once the color fades, pigment itself may stay in the skin indefinitely.

I have been informed that the highest standards of hygiene are met and that sterile, disposable needles and pigment containers are used for each individual client, procedure and visit.

I understand and accept that each procedure is a process requiring multiple applications of pigment to achieve desired results and that 100% success cannot be guaranteed during the first procedure. I understand that I may have to return for a repeated procedure.

Upon completion of the procedure there might be swelling and redness of the skin, which will subside within couple hours. In some cases, bruising may occur. You may resume normal activities following the procedure, however, using cosmetics, excessive perspiration and exposure to the sun should be limited until the skin has fully healed.


I have been advised that the true color will be seen 2-6 weeks after each procedure, and that the pigment may vary according to skin tones, skin type, age and skin condition.

Aftercare instructions have been explained to me and a written copy will be given to me to retain in my possession, which I will follow the best of my ability. If I have questions, I will call or email you.

I agree to follow all pre-procedure and post-procedure instructions as provided and explained to me by the technician. Failure to do so may jeopardize my chances for a successful procedure.


I certify that I have read or have had read to me the contents of this form. I understand the risks and alternatives involved in this procedure(s) and I have had the opportunity to ask questions and all my questions have been answered. I acknowledge that I have reviewed and approved the materials given to me and I authorize Ngoc T. Lam, owner and certified PMU technician/artist of Evesbrows, to perform on my face the procedure desired today.

October 2, 2024





HEALTH CONDITION QUESTIONNAIRE 


In order to perform the eyebrows drawing treatment in a safe manner, please answer the following health questions truthfully. Do you suffer from the following diseases or are you taking any of these medications?


Hemophilia*
No
Yes
Diabetes *
No
Yes
Hepatitis A,B,C*
No
Yes
HIV*
No
Yes
Skin disease*
No
Yes
eczema*
No
Yes
Allergies *
No
Yes
Autoimmune diseases*
No
Yes
Epilepsy *
No
Yes
Cardiovascular problems*
No
Yes
Are you prone of herpes? Had infection disease, high fever before *
No
Yes
Are you taking medication for blood thinning (anticoagulants)?*
No
Yes
Are you pregnant/breastfeeding?*
No
Yes
Taking medications on a daily basis?*
No
Yes
Do you have a Pacemaker?*
No
Yes
Do you have problems with healing wounds?*
No
Yes
Have you consumed drugs, stimulants, alcohol in the past 24 hours?*
No
Yes
Did you in the last 14 days undergo surgery, were you exposed to radiation or had any other medical intervention?*
No
Yes
First Client Name

First Name*

Middle Name

Last Name*

Phone*
First Client Date of Birth*
First Client Signature*
Second Client Name

First Name*

Middle Name

Last Name*
Second Client Date of Birth*
Second Client Signature*
Third Client Name

First Name*

Middle Name

Last Name*
Third Client Date of Birth*
Third Client Signature*
Fourth Client Name

First Name*

Middle Name

Last Name*
Fourth Client Date of Birth*
Fourth Client Signature*
Fifth Client Name

First Name*

Middle Name

Last Name*
Fifth Client Date of Birth*
Fifth Client Signature*
Sixth Client Name

First Name*

Middle Name

Last Name*
Sixth Client Date of Birth*
Sixth Client Signature*
Seventh Client Name

First Name*

Middle Name

Last Name*
Seventh Client Date of Birth*
Seventh Client Signature*
Eighth Client Name

First Name*

Middle Name

Last Name*
Eighth Client Date of Birth*
Eighth Client Signature*
Ninth Client Name

First Name*

Middle Name

Last Name*
Ninth Client Date of Birth*
Ninth Client Signature*
Tenth Client Name

First Name*

Middle Name

Last Name*
Tenth Client Date of Birth*
Tenth Client Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
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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*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
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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