Microblading Consultation and Consent Form

MEDICAL HISTORY

MEDICATION

PREVIOUS SKIN TREATMENT HISTORY

REASON(S) FOR TREATMENT

We strive to provide the best appropriate medical care for all patients requiring aesthetic medical treatments, please can you help indicate by completing the following section your reason for requiring aesthetic medical treatment.

CONSENT FORM MICROBLADING

have been fully informed by the medical aesthetician and understand  the following conditions relating to my cosmetic treatment:

• I have disclosed any medical conditions/medications and allergies to the best of my knowledge
• I am over the age of 18, I am not under the influence of drugs or alcohol and want to have microblading of the eyebrows performed. The general nature of cosmetic tattooing as well as the specific procedure to be performed has been explained to me.
• The cost of treatment has been advised and the specific treatment parameters have been discussed and established. I understand the prices quoted are per treatment.
• I have been informed of the nature, risks, and possible complications and consequences of permanent skin pigmentation.  I understand the permanent skin pigmentation procedure carries with it known and unknown complications and consequences associated with this type of cosmetic procedure, including but not limited to: infection, allergic reaction, scarring, inconsistent color, and spreading, fanning or fading of pigments.  I understand the actual color of the pigment may be modified slightly, due to the tone and color of my skin.  I fully understand this is a tattoo process and therefore not an exact science, but an art.  I request the microblading procedure and accept the permanence of the procedure as well as the possible complications and consequences of the said procedure.  I understand that while this is sometimes referred to as semi-permanent in nature, due to each indivudal’s reaction to pigment, the length of time pigment is present cannot be guaranteed.  In some cases, pigment will be permanent. 
• I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, or if I apply foundation or skin care products to the area it may result in adverse changes to my permanent cosmetics. I acknowledge some of these potential adverse changes may not be correctable. 
• I understand if I am undertaking corrective/cover up work my technician will be unable to gurantee the end result due to being unaware of what equipment and pigments were used by my previous technician and therefore I may need more frequent top ups than a person who has never undertaken Microblading.
• I confirm that I will agree to final pigment colors and shape prior to any work commencing and that the technician will keep a log of all equipment that has been used. 
• I accept after each treatment the area may seem red and appear slightly swolen, I can accept some discomfort, I also accept that the area immediately after treatment may appear darker and thicker than the end result. The color and density will slough away over the following 5-14 days, the healing process will vary from person to person. I accept that should I accidentally knock, pull or pick at the area I could get gaps.
• I confirm that I will strictly adhere to the aftercare instructions provided to me 
• I understand to maintain my cosmetic work I must return for a refresh top up every 12-18 months and should I not maintain them within the guidelines I will need to have a new treatment completed at a new treatment price.
• Pain: There is a possibility of pain or discomfort even after the topical aneasthetic is applied, Anaesthetics work better on some people than others.
• Uneven pigmentation: This can result from poor healing, infection, bleeding or many other causes. Your follow up appointment will likely correct any uneven appearance.

I have discussed, and am aware of the possible side effects of laser treatment as follows:

• Redness, itching and swelling are common side effects immediately after treatment and can sometimes occur up to 2 weeks following treatment.
• I understand that if I fall pregnant during my treatment course, I will have to discontinue my treatment and re-commence post-pregnancy. I am aware that I will no longer qualify for the guarantee if it is applicable.
• In some rare cases a more serious reaction could be Anaphylaxis, a form of a serious allergic reaction, if this were to occur I will need to contact my GP or the emergency department immediately.
• I can expect some redness or scabbing at the very worst case scenario (Scabbing occurs in around 5% of patients).

Data Protection and Privacy

We are committed to protecting your privacy. We take special precautions with your sensitive personal data and we will process your data lawfully and as described. We only process the data we need for as long as we need to and we respect all of your rights under GDPR. We will never sell, share or otherwise abuse your data. You can contact us at anytime to request your data, change your preferences or request that your data be deleted. GDPR is the European privacy law designed to protect you and give you control of your data.

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