BLUSH CONSENT FORM | THE HAUS OF BROWS

LIP BLUSH CONSENT FORM

First Name

Last Name

Email Address

Date of birth

PLEASE READ THE BELOW INFORMATION:

I hereby authorise Laura Batchelder to perform upon myself the following procedure(s):

- Lip blush

If any unforeseen condition arises in the course of this procedure(s), calling in her judgement in addition to, or different from those now contemplated, I further request and authorise him/her to do whatever she deems advisable and necessary in the circumstances.

I fully understand, as with all such procedures that this is not a science but rather an art. Depending on the procedure(s) selected, I accept responsibility for determining the colour, shape and position of eyebrows, eyeliner, lip-liner/lip shading, beauty mark, tattoo or other as agreed during the course of my consultation.

It is understood that a sensitivity test is available at least 24 hours prior to procedure for pigments and tropical anaesthetics. The purpose of the test is to detect allergic or other reaction. I understand that if I do not wait 24 hours after the skin test, for treatment that it is at my own risk if any allergy occurs.

I fully understand and accept that non-toxic pigments are used during the procedure(s) and that the cosmetic enhancement achieved may fade in between one to three years. Even though the colour has faded the pigment will stay in the skin indefinitely.

I have been Informed that the highest standard of hygiene is met, and the sterile disposable needles, and pigments 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 desirable results, and that 100% success cannot be guaranteed. I understand that this is why I need to return for a retouch procedure.

I understand that a retouch procedure will be performed one to three months after the initial procedure. I will book the appointment when it is convenient for both parties.

The result of the procedure is determined by the following.

Medication
Skin Characteristics (dry, oily, sun damaged and thickness)
Natural skin undertones (blending with chosen pigment)
Personal pH balance of skin, which changes from visit to visit
Alcohol intake or smoking
Post-operative care treatment

Upon completion of the procedure there may be swelling and redness of the skin, which will subside in between one to four days. In some cases bruising can occur. Clients may resume normal activities immediately following the procedure, however, using cosmetics, excessive perspiration and exposure to the sun on the affected area should be limited. See specific post- procedure instructions for details. Clients can however, be assured that the procedure, even after one treatment, appears acceptable and that they can appear in public without additional makeup on the affected area.

I have been advised that the true colour will be seen in one month after the procedure, and that the pigment may vary in colour according to skin tones, skin type, age and skin conditions. I understand that some skins except pigment more readily than others and no guarantee to an exact effect or colour can be given.

I am aware that the lip procedures may stimulate any dormant virus such as herpes (cold sores). I am informed that eye procedures may stimulate dormant eye disorders or eye infections, and that some medication can prevent absorption of the pigment.

To my knowledge I do not have any physical, mental, or medical impairment or disability that might affect my well-being as a direct or indirect result of my decision to have the procedure done at this time. I am at least 18 years old. I do not have a heart condition. I do not have epilepsy. I have not had hepatitis within the last year. I am not haemophiliac. I do not have HIV. I am not under the influence of drugs or alcohol.

I declare that I have read and understood all of the above information.

I agree to follow all pre-procedure instructions and post-procedure instructions as provided and explained to me by the technician View pre-care instructions here

Being of sound mind and body, I hereby release any and all responsibility. I accept any and all responsibility myself for any consequence that might stem from my decision to have any permanent cosmetics procedure performed by the technician

I understand that there are few effective methods for pigment removal. Laser removal has proven successful, however is a process.

For the purpose of documentation, I also consent to the taking of “before” and “after” photographs of said procedure(s).

I certify that I have read, and have had explained to me, and fully understand the above consent and procedure permit; that the explanations therein referred to were made, and I accept full responsibility for these and or other complications which may arise or result during or following the permanent cosmetic/tattoo procedure(s) which is/are to be performed at my request according to this consent and procedure permit, that all of blanks or statements requiring insertion or completion were filled in before I signed. I have read and understood the above information.

It's important that you read agree to the terms & conditionsRead our terms here

Due to the COVID-19 pandemic there are strict terms and conditions that we now have to adhere to. It is important that you read and understand these before having a treatment with us. Please read carefully and check to confirm. View COVID-19 terms

Select a date

Your Signature

Thanks for submitting!

LIP BLUSH CONSENT FORM

ADDRESS

OPENING HOURS

Pollen Pay Terms

Privacy Policy