Forms & Waiver Micropigmentation Precare Lash lift waiver Lash Lift Waiver Name * First Name Last Name Email * I am informing my technician of any of the following contraindicated conditions. * Dry Eye Syndrome Sjorgen's Syndrome Currently having Chemotherapy Ocular Rosacea Allergies to adhesive tape, fumes or eye remover NA I consent to having my eyes closed and covered for the duration of the 90 minute procedure. * Yes No I wear contacts * Yes No I agree to have an eyelash lift (perm) and/or eyelash tint applied to my natural eyelashes and/or retouched. By signing this agreement, I consent to the procedure of an eyelash perm or eyelash tint by my technician. * I agree I understand there are risks associated with having an eyelash perm and/or eyelash tint. I further understand that as part of the procedure, eye irritation, eye pain, eye itching, discomfort, and in rare cases eye infection or blurriness could occur. I agree that if I experience any of these medical conditions with my lashes that I will contact my technician and consult a physician at my own expense. * I agree I understand that even though my technician perms the lashes using the proper technique, the instruments, tapes, cleaners, eye gel pads, adhesives, and removers used may irritate my eyes or require a physician’s follow-up care. * I agree I understand and agree to the care instructions provided by my technician for the use and care of my permed and/or tinted eyelashes. I realize and accept the consequences of failure to adhere to these instructions may cause the eyelashes to not stay permed as long as told. * I agree I agree to the following Post-Lash Lift: * -No water can come in contact with the eye area for 24 hours after the application (including steam from hot shower) -No makeup until at least 24 hours after service -Avoid sleeping on your face when possible, and do not rub eyes -Avoid using oil containing sunscreens, moisturizers and cleansers on lashes -Do not use waterproof mascara -Brush lashes at least once a day I agree Acknowledgement and Waiver I am over 18 years of age and consent to the agreement of this service. This agreement will remain in effect for this procedure and all future procedures conducted by my technician. I have read and fully understand all information in this agreement. I release my technician from all liability associated with this procedure, which is performed with the utmost attention to safety and proper application using tools and products that the technician has been professionally trained to use. There are no guarantees for length of time the lashes will stay permed. I understand the aftercare instructions and will do my part to maintain my eyelashes. I understand that there are many factors that may affect the life of the eyelash lift such as water and moisture contact, weather conditions, and activities involving exposure to high temperatures. By signing below, I verify that I have read and understand the above statements and agree to them. * I agree Type Name Here * Thank you! General Consent Form Micropigmentation General Consent Form Micropigmentation Name * First Name Last Name Email * I understand that any of the following complications may occur as a direct or indirect complication of micro pigmentation (permanent & semi-permanent): 1. Discomfort: discomfort is usually mild. Each person’s tolerance is different. I consent to the use of topical anaesthetic to manage any discomfort. 2. Swelling in the area of treatment is minimal to moderate and usually subsides in a few days. 3. Bruising: Bruising may occur; if so, it usually resolves within a few days. Bruising that lasts more than a week is very uncommon. 4. Pigment darkness: Immediately following the procedure, my micro pigmentation will appear its darkest. This colour will fade over a few weeks and then heal to its lighter, final colour. 5. Pigment Irregularities and Retention: I fully understand that this is a tattoo process and therefore is an art, not a science. Being that there are many variables affecting the final outcome of the colour (individual skin and body chemistry, after-care, post-healing care, etc.), it is possible, however unlikely, that it may be different than I had anticipated. I understand that Drop Dead Gorgeous does not guarantee the amount of colour that will be retained at the end of the healing weeks. 6. I understand that all initial services require at least a secondary touch-up, as ideal results rarely can be achieved in one appointment only. Depending on skin type or after care, I may require additional touch-ups. 7. I understand that if my skin tone is darker, the colours will not show as much as compared to lighter skin. Although efforts will be made to match the colour I desire, the final colour will likely not match exactly; however, the final colour is usually close. *Note: Lip shading and lip liner procedures are a challenge on some clients. Natural lip colours that are on darker skin tones will not maintain as much tattooed colour compared to lips that are naturally lighter in colour. 8. Reaction to pigment: Reactions are extremely rare, however it is possible to develop an allergic reaction to the pigment, such that the treated area becomes very swollen, red and inflamed for days, weeks, months, or longer. I acknowledge that Drop Dead Gorgeous cannot reasonably determine whether I might have an allergic reaction to the pigments or process used in my tattoo, and I agree to accept the risk that such a reaction is possible. 9. Infection: It is extremely unlikely, but still a possibility. I acknowledge that infection is always possible as a result of obtaining a tattoo, particularly in the event that after care is not followed. I do not have medical or skin conditions such as (but not limited to) acne, scarring (keloid), eczema, psoriasis, freckles, moles or sunburn in the area to be tattooed that may interfere with said tattoo or its healing. If I have any infection or visible rash on my body, I have advised my technician. 10. After-Care: I understand that it is important to follow all home-care instructions when striving for optimal results. I have received after-care instructions and agree to follow them while my tattoo is healing. 11. Laser and Surgery: I understand that if I have any skin treatments, laser hair removal, plastic surgery, or any other skin altering procedures on or near the tattoo, it may result is adverse changes to the tattoo. 12. I understand that this list is not complete and that other complications not aforementioned may arise. If any complications arise, I will notify the office immediately. 13. I acknowledge that if I have any condition that might affect the healing of the tattoo, I will inform my technician. I am not under the influence of alcohol or drugs. 14. I acknowledge that I am over the age of 18 and I have truthfully represented that the obtaining of a tattoo is my choice alone. 15. I have read all pages of the consent; I understand the general nature of the proposed procedure, the risks and the expectations. I consent to the application of the tattoo. 16. I acknowledge that no guarantees or warranties have been made or implied regarding my results or my satisfaction with the results. 17. I am aware that facial tattooing may stimulate a cold sore breakout, and have already started a course of prophylaxis if I am prone to cold sores. 18: I consent to Drop Dead Gorgeous taking photographs both before and after my treatment for the express purpose of compiling a portfolio for prospective clients to examine the procedures completed by Drop Dead Gorgeous, or future promotional/marketing materials. I understand and agree all statements above Thank you! Eyebrow Lamination Consent Eyebrow Lamination & Tint Consent Name * First Name Last Name Email * I am informing my technician of any of the following contraindicated conditions. * Psoriasis Eczema Currently having Chemotherapy Alopecia Sunburn Ultrasensitive skin Skin wounds or rash in the treatment area Allergies to adhesive tape, fumes or eye remover Not Applicable I consent to my before and after photos being possibly used in promotional or marketing material for Drop Dead Gorgeous Day Spa Inc. * I consent I agree to have an eyebrow lamination (perm) and/or eyebrow tint applied to my natural eyebrows and/or retouched. By signing this agreement, I consent to the procedure of an eyebrow lamination by my technician. * I agree I understand there are risks associated with having an eyebrow perm and/or eyebrow tint. I further understand that as part of the procedure, irritation, pain, itching, discomfort, and in rare cases infection could occur. I agree that if I experience any of these medical conditions with my eyebrows that I will contact my technician and consult a physician at my own expense. I agree I understand that even though my technician perms the eyebrows using the proper technique, the instruments, tapes, cleaners, adhesives, and removers used may irritate my skin or require a physician’s follow-up care. I agree I understand and agree to the care instructions provided by my technician for the use and care of my permed and/or tinted eyebrows. I realize and accept the consequences of failure to adhere to these instructions may cause the eyebrows to not stay permed as long as told. * I agree I agree to the following post Brow Lamination: No water can come in contact with the eyebrow area for 24 hours after the application (including steam from hot shower or swear from intensive workouts) No makeup until at least 24 hours after service Avoid sleeping on your face when possible, and do not rub Avoid using oil containing sunscreens, moisturizers and cleansers on lashes Avoid using exfoliating (be it AHA, BHA or scrubs) and anti-ageing skincare around the brow area for three days before and after your treatment Avoid fake tanning products (including gradual tan) on the face for three days before or after your treatment, as it can discolour the eyebrow tint Do not use waterproof makeup on brows Do not tan for at least 48 hours before and after treatment Brush brows at least once a day, securing with gel or oil I agree I am over 18 years of age and consent to the agreement of this service. This agreement will remain in effect for this procedure and all future procedures conducted by my technician. I have read and fully understand all information in this agreement. I release my technician from all liability associated with this procedure, which is performed with the utmost attention to safety and proper application using tools and products that the technician has been professionally trained to use. There are no guarantees for length of time the brows will stay permed. I understand the aftercare instructions and will do my part to maintain my eyebrows. I understand that there are many factors that may affect the life of the eyebrow lift such as water and moisture contact, weather conditions, and activities involving exposure to high temperatures. By signing below, I verify that I have read and understand the above statements and agree to them. * I agree Type Name Here * Thank you! Medical & Personal Health History Medical and Personal Health History Who are you Name * First Name Last Name Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Emergency Contact Name * First Name Last Name Phone (###) ### #### Questions How were you referred to us? Do you regularly sun bathe or use tanning beds? * Yes No How often? When was your last tanning session? MM DD YYYY When was your last COVID vaccine? (If applicable): MM DD YYYY Are you currently under the care of a physician or specialist? * Yes No If yes, for what? Do you smoke? * Yes No If yes, how many a day? 5 Do you consume alcohol? * Yes No If yes, how often? Do you have tattoos? * Yes No Are pregnant or trying to conceive? * Option 1 Option 2 Are you breastfeeding? * Yes No Are you using birth control? * Yes No If yes, which one(s)? Do you any history of or currently have any of the following medical conditions? Cancer Diabetes High Blood Pressure Heart Disease Heart Conditions Pacemaker Anemia Arthritis Frequent Cold Sores Herpes HIV/AIDS Seizure Disorder Hepatitis Hormone Imbalance Thyroid Condition Bleeding Disorder Circulatory Disorders Any Active Infection Liver Disease Bruising Easily Eczema Psoriasis Skin or hair picking Lupus Connective Tissue Disease Bowel Disease Asthma Alopecia or Hypotrichosis Sinus Problems Stomach Ulcers Severe Allergies Epilepsy Autoimmune Disorders Keloid scarring Hyper/Hypo Pigmentation Do you have any other health concerns? Please list the name and approximate date of any operations or laser therapies you have had: Please list the type and date of any cosmetic injections or fillers you have had: What products do you currently use on your skin? (list all current skincare products) Do you have any known allergies? (list any that you have and describe the reaction you experience) Medications What oral prescriptions or OTCs are you presently taking? (Please list their names and what they are used for) What herbal supplements or vitamins do you use regularly, and how often? I certify that the preceding medical, medication and personal history statements are true and correct. I am aware that it is my responsibility to inform the Estheticians of my current medical or health conditions and to update this history. A current medical history is essential in order for our technicians to execute appropriate treatment procedures. * Line Do you consent to your before and after pictures being used for promotional material (social media or in house promotions)? * (no personal information will be shared) Yes No Would you like to receive emails (max once per month) informing you of promotions and specials, including discounts on services or products? * Yes No Thank you! Micropigmentation Postcare
