Dees Beauty Salon

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Consent For Eyebrow Drawing Using Microblading Technique

Between:

Company Name and Address: Dee’s Beauty Salon
35 Juniper Close
Chineham
Hampshire
RG24 8XH


&

Client Name :
Address.:

1. Client will be informed in detail about the eyebrow drawing treatment using Microblading technique by a student

  • Dee’s Beauty Salon is obligated to perform treatment in strict compliance with all hygiene and health protection measures

2. HEALTH CONDITION QUESTIONNAIRE

  • In order to perform the eyebrow drawing treatment in a safe manner, please answer the following health questions truthfully.

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

Hemophilia YesNo
Diabetes Mellitus (diabetes) YesNo
Hepatitis A, B, C, D, E, F YesNo
HIV + YesNo
Skin Diseases YesNo
Eczema YesNo
Allergies YesNo
Autoimmune diseases YesNo
Are you prone to herpes? YesNo
Infectious diseases / high fever YesNo
Epilepsy YesNo
Cardiovascular problems YesNo
Are you taking medication for blood thinning? (anticoagulants) YesNo
Are you pregnant? YesNo
Are you taking any medication on a daily basis? YesNo
Do you have a pacemaker? YesNo
Do you have problems with healing of wounds? YesNo
Have you consumed drugs or alcohol in the last 24 hours? YesNo
Did you in the last 14 days undergo surgery, were you exposed to radiation or had any other medical interventions? YesNo

This information is confidential and shall also be treated that way. It will not be shared with a third party. You accept to receive information to your e mail address from Dee’s Beauty Salon.

3. CONTRACTUAL OBLIGATIONS

I agree to photo taking and using the photos for advertising purposes. YesNo

4. WARRANTY

  • Dee’s Beauty Salon 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. BB-MB is liable for violations of the obligations specified under the Agreement.

5. EXPLANATION

  • The client is informed in detail by Dee’s Beauty Salon about the specific risks of eyebrow drawing treatment using Microblading technique.
  • The following risks are specifically explained to the client:
    • During the treatment, despite the staff expertise and all the precautionary measures, injury is possible.
    • Despite the application of the most advanced and top quality pigments, allergic reaction is possible but rare. The client is informed about this and he/she assumes liability.
    • During and after the treatment temporary swelling, redness and/ or itching 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 hair may occur and colour intensity may change.
    • In the firstseven days eyebrows are up to 40% darker and 10 – 15% thicker. Colour 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 expression.
    • 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 colour intensity is possible and that one or more additional treatments will be required
    • The minimum or maximum duration of eyebrow drawing treatment cannot be determined with certainty, nor can the warranty be given on performed treatment.
    • The first correction is done four weeks after the treatment. For oily skin it is necessary to perform more corrections.
    • Permanent make- up always leads to the skin injury. Therefore, it is important to carefully and gently nurture your skin after the treatment to allow healing without complications. Inadequate care in the healing phase of the skin can lead to poor results and Dee’s Beauty Salon cannot be responsible for it.
    • There is a small percentage of people where Permanent Make Up will not be successful, for example where they have excessively oily skin

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

  • Half an hour after the end of the treatment eyebrows should be gently wiped with Phi wipes (as provided) and a thin layer of Candy Cream (as provided) applied
  • This procedure shall be repeated three to five times a day to prevent scab formation.
  • For post treatment care use only provided cream or pure Vaseline. 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
    • Sunbeds/tanning salon
    • Saunas
    • Beauty treatments
    • Intense exercise resulting in sweating
    • Avoid contact with dust
    • DO NOT pick or scratch your eyebrows

Dee’s Beauty Salon is not liable in case of improper post- treatment care.

6. COMPETENCE

I confirm that I have read and understood the aforementioned information. YesNo
I received a clear and understandable response to all of my questions. YesNo
The treatment procedure and post-treatment care was explained to me in detail and I agree with it. YesNo
I do not have any further questions. YesNo
Client Signature:
Date:
Beauty Therapist Signature:
Date: