Microblading/PMU procedures normally require more than one treatment. For best results, most clients will need a touch-up session 4-8 weeks following their initial service.*Please check the boxes below to acknowledge that you have read the pre-care guidelines*
Client Contact Information:
List any medications you have been taking in past 6 months...
Have you received chemotherapy or radiation in the past year?
Have you ever had an allergic reaction to any of the following? (please check all that apply)
Have you ever had any of the following? (please check all that apply)
Microblading/PMU is a form of cosmetic tattooing. Touch-up procedures may be required to achieve best results. 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/PMU may be slightly uncomfortable. The pigments will fade. Immediately after the procedure, the pigment will appear 30-50% darker than the desired result. Although extremely rare, there can be an immediate or delayed allergic reaction to the pigment. Rarely, an allergic reaction can occur from anesthetics used during the treatment. If you do suffer from an allergic reaction, you should contact your doctor immediately. Signs of an allergic reaction may include redness, swelling, rash, and/or blistering. We cannot accept responsibility if the area to be treated does not respond to the numbing cream. Each individual is different according to their skin type. Some clients report the area to be completely numb, while others may experience some discomfort. For microblading/PMU procedures, a numbing cream/gel is used. The products are formulated to be perfectly safe and can be purchased over the counter from any pharmacy. 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 may experience mild redness/swelling that can last 1 - 4 days. You should always follow your post procedure advice/aftercare to achieve best results. 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. You may experience minor bleeding. If you have an MRI scan within 3 months following your microblading service, notify your doctor of your microblading/PMU treatment. I have received aftercare instructions and I’m fully aware of the aftercare procedures.
Please read this form fully and sign at the end. If you are unsure about a particular detail of the form, please speak to your artist.
If unforeseen conditions arise in the course of microblading/PMU procedure, I authorise my therapist to use their professional judgement to decide on what he/she feels is necessary in the given circumstances. I accept the responsibility for determining the color, shape and position of the microblading/PMU procedure as agreed during consultation. I fully understand and accept that non-toxic pigments are used during the procedure and that the result achieved may fade over a period of 1-3 years. Even once the color has faded, the pigment itself may stay in the skin indefinitely. I have been informed that the highest standards of hygiene are met and that sterile, disposable needles and pigment containers are used for each individual client, procedure and visit.I understand and accept that each procedure is a process requiring multiple applications of pigment to achieve desired results, and that 100% success cannot be guaranteed during the first procedure. I understand that I may have to return for a repeated procedure.The result of the procedure is determined by the following; medication, skin characteristics (dry, oily, sun-damaged, thick or thin skin type), personal pH balance of your skin, alcohol intake and smoking, post procedure after care. Upon completion of the procedure there may be minor swelling and redness of the skin, which will subside in 1-4 days. In rare cases, minor bruising may occur. You may resume your normal activities following the procedure, however, using cosmetics, excessive perspiration and sun exposure should be limited until the skin has fully healed. Please see aftercare instructions for more details. You can be assured that the procedure results will look acceptable for you to appear in public without additional makeup on the affected area.I have been advised that the true color will be seen 1 month after each procedure, and that the pigment may vary according to skin tone, skin type, age and skin condition. I understand that some skin types accept pigment more readily and no guarantee on exact color can be given.To my knowledge I do not have any physical, mental, or medical impairment or disability that might affect my well being as a direct or indirect result of my decision to have the procedure done at this time. I agree to follow all pre-procedure and post-procedure instructions as provided and explained to me by the artist. I can confirm that I have received a copy of aftercare instructions. Being of sound mind and body, I hereby release any and all responsibility. I accept any and all responsibility myself for any consequences that might stem from my decision to have any permanent cosmetics procedure performed by: HEATHER McCAULEYFor the purpose of documentation, record and use in portfolio, I consent to having “before” and “after” photographs taken of my procedure. I CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE CONSENT FORM; THAT THE EXPLANATIONS THEREIN REFERRED TO WERE MADE AND ACCEPT FULL RESPONSIBILITY FOR THESE AND/OR OTHER COMPLICATIONS WHICH MAY ARISE OR RESULT DURING OR FOLLOWING THE MICROBLADING/PMU PROCEDURE. THE TREATMENT IS PERFORMED AT MY REQUEST ACCORDING TO THIS CONSENT, PRECARE GUIDELINES AND TREATMENT INFORMATION . I HEREBY AUTHORIZE ARTIST Heather McCauley TO PERFORM A MICROBLADING PROCEDURE ON ME AT MICROBLADING INDY in Fishers, IN.
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