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Welcome to Be Brows!

1. Client will be informed in detail about the eyebrow drawing treatment using Microblading technique by Be Brows is obligated to perform treatment in strict compliance with all hygiene and health protection measures.

2. POSSIBLE RISKS, HAZARDS OR COMPLICATION

• Pain: There can be pain even after the topical anesthetic has been used. Anesthetics work better on some people than others. Lip procedures are more likely to involve some pain.

• Infection: Infection is very unusual. The areas treated must be kept clean and only freshly cleaned hands should touch the areas. See “After Care” sheet for instructions on care.

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

• Asymmetry: Every effort 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.  

• Excessive Swelling or Bruising: Some people bruise and swell more than others. Ice packs may help and the bruising and swelling typically disappears with 1-5 days. Some people don’t bruise or swell at all.

• Eye Exposure: There is a small risk of eye injury when an eyeliner procedure is performed. To avoid corneal abrasion, Celluvisc, a thick eye drop is used to protect the eye prior to the procedure. Eye drops are used to cleanse and flush the eye after the procedure is complete.  

• Anesthesia: Topical anesthetics are used to numb the area to be tattooed. Lidocaine, Prilocaine, Benzocaine, Tetracaine and Epinephrine in a cream or gel form are typically used. If you are allergic to any of these please inform me now.

• 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 technician of any tattoos or permanent cosmetics.

• Fever Blisters: If you are prone to cold sores or fever blisters, (herpes simplex), there is a high probability that you will get them. It is advised that you call your doctor for a prescription antiviral to help prevent this from occurring.  

• Allergic Reaction: There is a small possibility of an allergic reaction. You may take a 5-7 day patch test to determine this.

The alternative to these possibilities is to use cosmetics and not undergo the Permanent Cosmetics procedure.

Consent and release for procedures performed:

 

Signature 

                                                              Date: April 28, 2024

3. STATEMENT OF CONSENT AND RECITALS:  

Please read and initial all lines


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 to the best of my ability. If I have questions I will call or email you.


I understand that a certain amount of discomfort is associated with this procedure and that swelling, redness and bruising may occur.  


Fever blisters may occur in lip procedures in individuals who have the herpes simplex virus and it is my responsibility to obtain a prescription from my doctor for an anti-viral medication to help avoid a breakout.


I understand that Retin A, Renova, Alpha Hydroxy and Glycolic Acids must not be used on the treated areas. They will alter the color.


I understand that sun, tanning beds, pools, some skin care products and medications can affect my permanent makeup.


I understand that successful lip color saturation can NOT be guaranteed due to hidden scar tissue.


I will tell all skin care professionals or medical personnel about my permanent makeup procedures, especially if I’m schedule for an MRI.


I accept the responsibility for explain to you my desire for specific colors, shape, and position for any procedure done today.


I understand that implanted pigment color can slightly change or fade over time due to circumstances beyond your control and I will need to maintain the color with future applications and a touch up session within 60 days. 


I acknowledge that the proposed procedure(s) involve risks inherent in the procedure and have possibilities of complications during and/or following the procedures such as: infection, misplaced pigment, poor color retention and hyper-pigmentation.


I have been quoted the cost of today’s appointment, 2nd session is $100 (6-8 weeks after the 1st visit, if you go longer, it will cost more, and yearly touch up is $250 (9 months-1 year from last visit) if needed. There will be no refunds for this elective procedure(s).


I get the touch up price which is based on the time frame from my last visit (+ $50 for Blade+ Shade Clients, + $100 for Non Blade + Shade Clients)

          $100+ (6-8 weeks after your previous visit)

          $150+ (8 weeks to 6 months after your previous visit)

          $200+ (6 months to 9 months after your previous visit)

          $250+ (9 months to 1 year after your previous visit)

          $300+ (12 months to 18 months after your previous visit)

          $350+ (18 months to 24 months after your previous visit)

          Full price if it's over 24 months after your previous visit


I understand that if I go longer than 24 months from last visit, new procedure with new price will be applied.


I accept full responsibility for the decision to have this cosmetic tattoo work done.


I release Be Brows from all claims and liabilities relating to the procedure, healing result

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 of my questions have been answered. I acknowledge that I have reviewed and approved the material given to me and I authorize Be Brows Team Member, as my permanent cosmetics technician to perform on my body the following procedures.

 

Signature

Date April 28, 2024

4. EXPLANATION

During the treatment, despite the staff expertise and all the precautionary measures, the injury is possible.

Despite the application of the most advanced and the 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 hairs may occur and color intensity may change. In the first seven days eyebrows are up to 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 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 color 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 healing phase of the skin can lead to poor results and Be Brows cannot be liable for it.

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 thoroughly rinsed with lukewarm water, and then a thin layer of Vaseline (petroleum jelly) shall be applied. This procedure shall be repeated every hour, at least 5 times a day to prevent the 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, tanning salon, sauna, beauty treatments and intense training accompanied by sweating (sport activities ), contact with the dust (household chores, etc.).

Be Brows is not liable in case of improper post-treatment care.


First Client Name

First Name*

Middle Name

Last Name*

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

First Name*

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

First Name*

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Third Client Date of Birth*
Fourth Client Name

First Name*

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Fourth Client Date of Birth*
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First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Sixth Client Date of Birth*
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First Name*

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Seventh Client Date of Birth*
Eighth Client Name

First Name*

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Eighth Client Date of Birth*
Ninth Client Name

First Name*

Middle Name

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Ninth Client Date of Birth*
Tenth Client Name

First Name*

Middle Name

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

Email*

Confirm Email*
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5. 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 the following diseases or are you taking any of these medications?

Hemophilia*
No
Yes
Diabetes mellifluous (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
Autoimmune diseases*
No
Yes
Are you prone to herpes?*
No
Yes
Infectious diseases / high fever*
No
Yes
Epilepsy*
No
Yes
Cardiovascular problems*
No
Yes
Are you taking medication for blood thinning (anticoagulants)?*
No
Yes
Are you pregnant?*
No
Yes
Are you taking any medications on daily basis?*
No
Yes
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 in the last 14 days undergo surgery, were you exposed to radiation or had any other medical interventions?*
No
Yes
Keloid*
No
Yes
I agree on photo taking and using the photos for advertising purposes.*
No
Yes
6. COMPETENCE
I confirm that I have read and understood the aforementioned information.*
No
Yes
I received a clear and understandable response to all my questions.*
No
Yes
The treatment procedure and post-treatment care was explained to me in detail and I agree with it.*
No
Yes
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 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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