Microblading Consent Form

top of page

Home
About
Services
Forms
Contact
More

Use tab to navigate through the menu items.

BOOK ONLINE

First Name

Surname

Street Address

Street Address Line 2

City

Postal / Zip code

I hereby authorise Jacqueline Thomas to perform upon myself a permanent cosmetic/medical enhancement. If any unforeseen condition arises during the procedure(s) I further request and authorise her to use her full judgement and do whatever he/ she deems advisable and necessary in the circumstances.

I understand that permanent cosmetic/medical enhancement is an advanced form of tattooing.

I accept responsibility for determining the colour, shape and position of the enhancement as agreed during my consultation.

I understand that a sensitivity test for pigment does not guarantee that I will not have an allergic response. I am aware of that allergic response to pigment is rare and accept all responsibility if allergic response occurs.

I am aware that a sensitivity reaction to anaesthetics can occur and accept all responsibility if allergic response occurs.

I fully understand and accept that non-toxic pigments are used during the procedure and that the cosmetic enhancement achieved may fade over the course of 1-3 years. Even though the colour has faded, the pigment will stay in the skin indefinitely and may leave a light residue of colour.

I accept that the highest standards of hygiene are met, and that sterile disposable needles 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 desirable results, and that 100% success cannot be guaranteed. I understand that therefore I need to return for a control procedure that is included in the initial price.

I understand that the control procedure, if required, will be performed 1-2 months after the initial procedure and that after a 2-month period I will be charged an additional fee for any procedures. I understand that a control procedure takes place 4-8 weeks after the initial application to allow the procedure site to fully heal. I will book the appointment when it is convenient for both parties.

I understand that the pigment may migrate under the skin, however this is a rare occurrence.

I understand that permanent cosmetic enhancement is an invasive procedure, and the infusion process can be uncomfortable.

I am aware that the result of the procedure is determined by the following: Medication, Skin Characteristics - i.e. dry/oily/sun-damaged, Natural skin undertones, Alcohol intake, smoking, general stress, a compromised immune system, poor diet, a post procedure care treatment and

I have been advised that upon completion of the procedure there may be swelling and redness of the skin, which will subside within 1-4 days dependent on lifestyle. In some cases, bruising can occur. I have been advised that I can resume normal activities immediately following the procedure, however, using cosmetics, prolonged exposure to water, excessive perspiration and exposure to the sun should be limited for up to two weeks following the infusion process.

I understand that immediately after the procedure the enhancement can be 30 to 50% darker than the desired result and can take between 4-10 days to lighten. I understand that the true colour will be visible 1 month after each application, and that the colour may vary according to skin tones, skin type, age and skin conditions. I appreciate that some skins accept colour more readily than others and no guarantee of an exact effect or colour can be given.

I understand that there are few effective methods for pigment removal. Laser removal has proven successful, however is a process.

I agree to inform my doctor of my permanent cosmetic enhancement if I require a MRI scan within a 3-month period of receiving the procedure.

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 am at least 18 years old. I am not under the influence of drugs or alcohol.

I understand that if I do not allow the technician to complete the procedure, I accept all responsibilities for the result.

For the purpose of documentation, I also consent to the taking of “before” and “after” photographs of said procedure(s).

I understand that micropigmentation is an art process and is not an exact science and that every client heals differently.

I confirm I will strictly adhere to the typed after-care instructions posted/handed to me, and only use the after-care products given. I understand that complications are possible, particularly if post-procedure aftercare instructions are not followed and if I get an infection post-procedure I will visit my doctor immediately and accept that it could be because I did not follow the aftercare instructions. If I have any questions or queries after the procedure, I will telephone the technician to discuss.

I fully understand that the skin type of every client is different and have been advised that pigment should stay visible in the skin for up to 2 years (and in some cases indefinitely). Also, that lighter colours will fade quicker than darker colours, and that colours might change with time.

If considering BOTOX or COLLAGEN, please note injectables can alter the position of the eyebrows.

I understand that future laser treatments or other skin altering procedures, such as plastic surgery, chemical peels, implants, and/or injectable may alter my semi-permanent make-up.

I understand that semi-permanent make up fades over the time and annual retouches may be required to refresh the colour. Semi-permanent make up fading depends on medication, skin characteristics (dry/oily/sun-damaged), natural skin undertones, compromised immune system, poor diet, sun/sunbeds exposure (use SPF 50 cream to protect quick fading), chemical peels, hormone changes.

If I have any concerns, I will contact Jacqueline Thomas directly. I will not write any negative reviews online about Jacqueline Thomas or Missy Beautique. I understand that any defamation against Jacqueline Thomas or Missy Beautique will result in a fine and court proceedings.

I CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE CONSENT FORM AND THAT I HAVE REQUSTED TO HAVE PERMANENT COSMETIC ENHANCEMENT OF MY OWN FREE WILL.

I understand the following colour boost cost layout.

Colour Boosts

0-2 months £0.00

2-6 months £50.00

6-12 months £75.00

12-18 months £125.00

18-24 months £175.00

24 months + £225.00 (including a top up)

Date of patch test

Date of procedure

Your Signature

Today's date

Thanks for submitting!

Thursday 9am - 7:30pm

Friday 9am - 5:30pm

Saturday 9am - 4pm

Monday CLOSED

Tuesday 9am - 5:30pm

Wednesday 9am - 5:30pm

Terms and Conditions

Privacy Policy

Consent Form

Medical Form

bottom of page