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Date of birth
Date of treatment

Medical history

Please answer the following questions truthfully:

Are you pregnant or breast feeding?
Yes
No
Do you have any known allergies, including allergies to makeup, pigments, or anaesthetics?
Yes
No
Do you have any of the following conditions?
Are you currently taking any medications, including blood thinners or acne medication?
Yes
No
Do you have any history of adverse reactions to tattoos or permanent makeup?
Yes
No

Procedure Information

Please read and sign each statement:

I understand that ombré brows are a semi-permanent cosmetic procedure that involves the application of pigment into the skin to create a soft, shaded brow effect.

I understand that the final result may vary depending on factors such as skin type, age, and aftercare, and that results are not guaranteed.

I understand that a touch-up session may be required 4-6 weeks after the initial procedure to achieve the desired result.

I have been informed that temporary redness, swelling, and tenderness may occur after the procedure and that these symptoms typically subside within a few days.

Aftercare instructions

Please read and initial each statement to confirm your understanding:

I agree to follow the aftercare instructions provided by Affinity Beauty Clinic to ensure the best possible results.

I understand that failure to follow the aftercare instructions may result in complications, poor healing, or loss of pigment.

I agree to keep the treated area clean and dry, avoid excessive sweating, and refrain from using makeup or skincare products on the brows for at least 7 days after the procedure.

I understand that exposure to the sun, tanning beds, or swimming pools should be avoided for at least 2 weeks after the procedure.

Release of Liability and Consent

Please read and sign the following:

  • I, the undersigned, acknowledge that I have been fully informed of the nature, risks, and possible complications of the ombré brows procedure. I understand that the results may vary and that no guarantees have been made regarding the outcome.

  • I hereby release Rebekah and Affinity Beauty Clinic from any liability for any harm, injury, loss, or damage that may occur as a result of this procedure. I understand that the procedure is elective and that I have chosen to undergo it of my own free will.

  • I confirm that I have disclosed all relevant medical information, including any allergies, medications, or pre-existing conditions that may affect the outcome of the procedure.

  • I agree to follow the aftercare instructions provided to me and understand that failure to do so may affect the results of the procedure.

  • I consent to having photographs taken before, during, and after the procedure for documentation purposes. I understand that these photographs may be used for promotional purposes, and I grant permission for their use unless otherwise specified in writing.

  • I confirm that I am at least 18 years old and legally capable of giving consent.

Date
Date

Client Satisfaction & Acknowledgment of Results

I, hereby confirm that I have thoroughly examined my ombré brows following the procedure conducted by Rebekah at Affinity Beauty Clinic.


I acknowledge and agree to the following:

  1. Satisfaction with Results:

    • I am satisfied with the appearance of my ombré brows as they currently stand. I have had the opportunity to review the results both in person and in a mirror, and I understand that the final healed result may vary slightly as the pigment settles into the skin.

  2. Procedure Outcome:

    • I understand that ombré brows are a semi-permanent cosmetic procedure, and the outcome is influenced by factors such as my skin type, lifestyle, and aftercare. I acknowledge that results may fade over time and that touch-ups may be required to maintain the desired look.

  3. Aftercare Compliance:

    • I have received and understand the aftercare instructions provided by Affinity Beauty Clinic. I acknowledge that I am responsible for following these instructions diligently to ensure optimal healing and results. I understand that failure to do so may affect the longevity and appearance of my brows, and I release the technician and the clinic from any liability related to non-compliance.

  4. No Further Claims:

    • By signing this document, I confirm that I am happy with the results of my ombré brows and release Rebekah and Affinity Beauty Clinic from any further claims, disputes, or demands related to the procedure, its outcome, or my personal satisfaction. I understand that no further alterations or corrections will be made unless explicitly discussed and agreed upon.

Date
Date
Applying Mascara
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