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New Client Info and Health Booking Form

New Client Info and Health Booking Form

If you are a new cosmetic tattoo client please fill in an online BOOKING FORM. This form will take you through all the important information to make an informed choice of whether or not to undergo a cosmetic tattoo application. At the end of the form, a booking fee will be required to hold your appt and will be applied to your total cost. Please carefully read and tick/answer every question on the form. You will be able to book your appointment online at the end. Thank you! 
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    ex. Friend, Google, Instagram, Facebook.
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    Please take a picture in a good lighting for a review and we'll get back to you ASAP
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    Think of shape, colour, density, thickness  
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    Many women are more sensitive during their menstrual cycles, please consider this when scheduling permanent makeup procedures.

    Micropigmentation is a tattoo and therefore a minor injury to the skin which takes time to heal. If you are planning a vacation involving sun, swimming or activities that may exert you to the point of perspiration, you must give your skin a minimum of two weeks to heal post procedure. Perspiration has salt, salt removes pigment, it also puts the client at a higher risk of infection.

    If you have ANY special events planned within 1-2 weeks following the procedure, it is the client’s responsibility to disclose this to the technician, preferably at time of scheduling. Everyone heals differently, you do not want to show up for your wedding, class reunion or company party with flaking eyebrows, eyelidsor lips.

    If a client arrives for their appointment, and any of the aforementioned contraindications and/or conditions, i.e., sunburn, eczema, psoriasis, chronic acne or rosacea, etc. are visible, the technician reserves the right to refuse service, and the client will be charged the equivalent of a “No Show / No Call” fee.

    Should a medical release be required to proceed, and the appointment must be re-scheduled, the client will be charged the fee equivalent to a No Show/No Call situation.

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    All clients are required to read “Our Policies” which are available on our website. By scheduling services, clients acknowledge that they have read these documents in full, understand them, accepts terms and conditions and agree to follow Pre-procedure and After care instructions. Failure to do so, may result in rescheduling and/or cancellation of services, and incur fees.
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    Check all apply
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    Although rare, there may be an immediate or delayed allergic reaction to pigment. You may take 5-7 days to determine this. A negative patch test result does not guarantee that you will not develop an allergic reaction after procedure. Seek immediate medical attention in the event of a suspected reaction. 
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    Please read the following statements carefully and tick to acknowledge your understanding of each.
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    I am over the age of 18, am not under the influence of drugs or alcohol, am not pregnant and desire to receive the indicated permanent cosmetic procedure. The general nature of cosmetic tattooing as well as the specific procedure to be performed has been explained to me. I absolutely understand and accept that such procedure is a process, often requiring multiple applications of colour to achieve desired results. To achieve the best results, you will be required to return for at least one control procedure 4 to 6 weeks after the initial application. Cost of the additional session is $200. Previously tattooed areas (by not us) will almost always require additional sessions and will be charged accordingly. Some special cases may be considered. A minimum healing period of 6-8 weeks is required before a touch-up procedure can be performed. Procedures with the interval more than 2 months are not counted as additional. I understand that the colour selection and results in all procedures are not an exact science and that the actual colour of the pigment may be modified slightly, due to the tone and colour of my skin. Taking before and after photographs of the said procedure(s) are a condition of such procedure(s). Implanted pigment colour can slightly change or fade over time due to circumstances beyond your control and I will need to maintain the colour with future applications. I state that I’ve received written after care instructions and I will strictly adhere to such instructions. understand that sun, tanning beds, pools, some skin care products and medications can affect my permanent makeup.I understand that many lasers & IPL’s (Intense Pulse Lights) including those used for hair removal, anti-aging, Photo Facials, removal of lines may or will turn permanent makeup dark or even black. I agree to inform my aesthetician or anyone operating such equipment that I have permanent makeup. I am aware that if I am to receive an MRI after the procedure, I must tell the Radiologist that I have iron oxide permanent cosmetics. I acknowledge micro-pigmentation procedure carries with it known and unknown complications and consequences associated with this type of cosmetic procedure, including but not limited to: minor and temporary bleeding, bruising, redness or other discolouration, swelling, poor colour retention or loss of pigment, scarring, inconsistent colour, infections, misplaced pigment, hyperpigmentation fanning or fading of pigments. I am aware that if an infection occurs after I have received micro pigmentation, that I am to seek immediate medical treatment from either my primary physician or hospital Emergency Room, and that I must notify my practitioner. There is a possibility of an allergic reaction to pigments. A patch test is advisable however it does not ensure a client will not have an allergic reaction. If patch test is waived, I release the technician from liability if I develop an allergic reaction to the pigment. I accept the permanence of the micro pigmentation procedure as well as the possible complications and consequences of the said procedure(s). I fully trust my service provider to perform the procedure of the micro pigmentation and agree that the service provider is not responsible for any individual reactions of my body.I have read and understand the risks listed above and they have been explained to me. I certify that the information in the above questionnaire is accurate and the questions have been answered truthfully to the best of my knowledge. I accept full responsibility for the decision to have this cosmetic tattoo work done.
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    BOOKING A NEW SERVICE REQUIRES TWO SESSIONS (we will book your second appt in person). A NON REFUNDABLE BOOKING FEE IS REQUIRED TO HOLD ANY APPT AND WILL BE APPLIED TO YOUR TOTAL COST.
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