microblading client form

NEW CLIENT MICROBLADING FORM

general client info

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Would you like to receive text message appointment reminders? *

Yes No

Cell Phone Carrier *

How did you hear about us? *

Friends or Family Google/Internet Search Yelp Other

Who can we thank for referring you? *

microblading precautions

PLEASE READ CAREFULLY AND SIGN BELOW:

Microblading procedure normally requires multiple treatment sessions. For best results, clients will be required to return for at least one re-touch appointment. This will take place between 4-6 weeks after the initial procedure.
Please be aware that color intensity will be significantly darker and sharper immediately after the procedure. This will reduce by 30%-50%
Although numbing cream is used during the procedure, slight sensitivity/ discomfort may still be felt by sensitive clients.
Delicate or sensitive skin may be red and/ or swollen after the procedure.
Please wear your normal make-up to the salon on the day of your procedure.
Please do not drink alcohol the night before treatment.
Where possible, try to avoid the following herbs and spices prior to your appointment:
Black pepper (Piper nigrum), Cardamom (Elettaria cardamomum), any member of the
Zingiberaceae (Ginger) family Cayenne (Capsicum frutescens) Cinnamon (Cinnamomum cassia),
Garlic (Allium sativum), Horseradish (Armoracia lapathifolia), Mustard - A patch test will be
performed, unless waived upon request.
Any brow shaping using waxing should be performed at least 48hrs before the treatment.
Electrolysis treatment should be undergone no less that 5 days before the treatment.
AHA preparations should be undergone no less than 2 weeks before the treatment.
Chemical, laser peel or Retin-A should not be utilized 6 weeks before the procedure.

Allergic Reactions & Numbness:

Allergic reaction: can occur from any anesthetics using during 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.

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.

Procedure: For microblading procedure a numbing cream/gel is used. The products are formulated to be perfectly safe and can be purchased over the counter from any pharmacy/chemist. The anesthetic is placed over the treatment area for 20-30 minutes then carefully removed prior to treatment. As a result of the treatment, combined with the use of the anesthetic you can expect to experience some redness/ swelling that can last 1 - 4 days. You should always follow your post procedure advice/ after care for the best results.

I have read and fully understood the above information provided and any risks involved with the use of topical anesthetic and I therefore consent to the use of the anesthetic for the microblading procedure. I agree to follow pre-procedure advice closely.

Signature *

HEALTH QUESTIONAIRRE

Are you pregnant? *

Yes No

Have you been waxed before? *

Yes No

Have you received a severe sunburn in the past 2 months? *

Yes No

Have you tanned (not spray tan) in the past 72 hours?* *

Yes No

Do you bruise easily? *

Yes No

Do you scar easily? *

Yes No

Are you pregnant or breastfeeding? *

Yes No

Do you have difficulty healing? *

Yes No

Have you received any laser treatments in the past 72 hours?* *

Yes No

BROW QUESTIONNAIRE

Please Explain your main concerns relating to your eyebrows *

What would you like to improve in regards to shape, color, density, thickness *

Photos Required:

Please upload clear photos of your eyebrows in in-direct sunlight (stand in front of a window). Straight on, and each brow at a 45 degree angle. Here are some examples:

Upload File *

Max file size: 20MB

Upload File *

Max file size: 20MB

Upload File *

Max file size: 20MB

Please upload a picture of your brows that you absolutely love (even if they are filled in or from a long time ago)

Upload File *

Max file size: 20MB

Please upload a picture of eyebrows that you would like yours to look like

Upload File *

Max file size: 20MB

MICROBLADING DISCLAIMER

Please read the following statements carefully:

Microblading is a way of cosmetic tattooing. Re-touch procedures may be required. A healing period of 4 weeks is required before a touch up procedure can be performed. On a rare occasion, the pigment may migrate under the skin. Procedure of microblading may be slightly uncomfortable. The pigments will fade. Immediately after the procedure, the pigment can appear 30-50% darker than the desired result. Although extremely rare, there might be an immediate or delayed allergic reaction to pigment. A negative patch test result does not guarantee that you will not develop an allergic reaction after the full procedure. Allergic reactions to anesthetic can occur. Permanent cosmetics cannot be applied to pregnant women or nursing mothers. Permanent cosmetics cannot be applied to any person under the age of 18. Infections can occur if aftercare instructions are not followed correctly. There may be swelling and redness following the procedure. You may experience minor bleeding. If you have an MRI scan within 3 months after microblading procedure, you should notify/ discuss with your doctor. Possible scaring may occur, but is extremely rare.

Initial that you read and understand the above statement *

policies & requirements

Scheduling Policies:
Scheduling Policies: We require 72 hours notice for canceling appointments. We ask this so we may open up your time-slot to another microblading client. Cancellations made less than 72 hours may result in a charge of the scheduled appointment. No-show appointments will be charged the full amount of the treatment scheduled. Your scheduled appointment is booked for you and only you, our Artists cannot fill no-show appointments, so we ask our clients to have consideration for their Artist. When scheduling your appointment, we require a credit card number to hold your appointment, along with a deposit of $200.

Initials *

Confirmations:
Appointments MUST be confirmed, and we've made it SUPER easy to do so! Each client receives a confirmation email 72 hour before their scheduled visit. This email has a big green button to click that says "confirm". Texts are also sent if you are signed up for them, simply reply "YES". If these go unconfirmed, we will call you for a confirmation day before.

Initials *

confirmation

I have completed this form to the best of my knowledge and agree the information I have provided is true and accurate. OC Waxing is not responsible for any side effects caused by inaccurate information I have disclosed on this form. I understand that while every precaution is taken, adverse reactions are a possibility when microblading; including skin irritation, lifting etc. I understand that any contraindication boxes I checked on this form can increase my chances of adverse reactions to microblading services. I understand that all health history information I have provided is confidential and cannot be shared with anyone other than OC Waxing and their employees. I give OC Waxing and their Microblading Artists permission to perform services I request.

Please Type Full Name *

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NEW CLIENT MICROBLADING FORM

general client info

microblading precautions

HEALTH QUESTIONAIRRE

BROW QUESTIONNAIRE

MICROBLADING DISCLAIMER

policies & requirements

confirmation

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