BOOKING TERMS & CONDITIONS
I am aware that all booking fee's are non refundable under any circumstances
Booking fee's are transferable ONCE and only if you have given us 48 hours notice (weekends not included)
Should the required noticed not be given, your booking fee will be lost and you will be required to pay another before we schedule an appointment for you
No shows / cancellations within 48 hours will require 50% of the balance of the treatment paying before we reschedule your appointment. This payment is not redeemable from the new appointment
Your 6 week top up is charged at £50 and any follow up's (should you need it) within 3 months are charged at £50
If you have had previous Semi-Permanent Makeup please consult with us prior to making any booking to confirm that we are happy to work over your previous work
Patch tests are recommended for all SPMU treatments although not mandatory. If you do not choose to come for a patch test you will be asked to sign the waiver below. You do not need to make an appointment for a patch test Monday to Friday 9:30am-4pm
Cash is preferable for your treatment balance on the day
I fully agree and accept the above terms *
Signature:
Caffeine & Alcohol needs to be avoided at least 12 hours prior to your appointment. This increases the chances of you bleeding which can flush the pigment out.
Please avoid any UV exposure 1 week prior, as we can't tattoo burnt skin.
You may be turned away if you are not properly prepared for your appointment and your booking fee will be lost.
I fully understand the above advice *
Semi-Permanent Make Up, also known as Micropigmentation is a procedure that can only be performed by a trained and qualified specialist using approved equipment to implant coloured pigments into the skin using sterile needles. The treatment requires your full consent and medical history so that we can confirm you are a suitable candidate for the proposed treatment.
PLEASE READ CAREFULLY – PLEASE SIGN WHERE INDICATED, ONLY when you are happy to proceed.
TERMS OF YOUR TREATMENT
You have chosen a cosmetic procedure that is not medically necessary and results are not guaranteed.
SPMU is an art process, not an exact science - and cannot guarantee an exact colour result due to how colours can heal differently in all individuals. The selected colour will be darker immediately after treatment. This darker colour should exfoliate and lighten within 7-14 days after treatment. Lighter colours fade faster than darker colours, and all colours can change with time.
You will be required to return for a top up 6-8 weeks after the initial treatment which will deem your brows complete. In some rare cases, you may be required to return for a second touch up session to achieve the desired result at the normal top up charge.
Your consultant will use a treatment plan to record the colours, needles used and pre and post treatment photographs. This information will be held securely in your consultation record.
The skin type of every client is different and annual top ups are recommended. Please note that some clients may require a 6 week top up after the annual top up depending on how well the treatment has held.
After each treatment some swelling or redness may occur, in some cases there may be bruising. Throughout the treatment you may experience some discomfort, but your consultant will reassure you throughout and endeavor to make you feel comfortable.
Pigments used in Semi Permanent Make Up contain iron oxides which differ to the inks used in tattooing. Please note that iron oxides can leave an orange stain in the skin overtime, this is more visible when you are due an annual touch up.
It is essential that is you ever have an MRI or a CAT scan you should inform the radiologist that you have had micropigmentation. You may experience some tingling in the treated area but this will not hinder or affect anything.
You must adhere to aftercare instructions given to you after your treatment. This is very important and will ensure you aren’t vulnerable to infections after leaving the clinic. You must let the treated area heal properly. Avoid picking, plucking or knocking as this will hinder the healing process and could make the treatment appear uneven thus requiring further work.
Be aware that skin altering procedures such as plastic surgery, implants and injectables may alter the Semi Permanent Make Up look.
First Name * :
Last Name * :
Street Address * :
Address Line 2:
City * :
Phone Number * :
Email * :
Date of Birth * :
Signature * :
PATCH TEST / WAIVER: (Please tick A or B) *
(A) I have undergone or been offered an allergy test prior to my initial treatment and I therefore release the technician from any liability related to allergic reactions to the applied pigments or other products used after the procedure ,or at a later date.(B) I understand that a skin test can determine whether I will suffer a reaction to the products used, but that it is inconclusive whether I will have an allergic reaction at any time in the future. I therefore waiver my option to an allergy test and wish to proceed with treatment.
CONSENT
I understand that my consultant will be in direct contact with me in relation to the micro pigmentation treatment. This treatment involves the use of disposable needles and that all other equipment is sterilized before use, all surfaces involved in the process are protected and that gloves will be worn at all times by the consultant during the treatment.
I hereby consent to receiving a micro pigmentation treatment. My consultant has explained the terms and conditions of the treatment and I have fully understood these. I hereby give written consent to the consultant who is a trained specialist, to carry out the treatment of my choice as requested by me on this consent and treatment agreement.
Print Name * :
Date * :
PHOTOGRAPHIC CONSENT
I consent to photographs being taken BEFORE, DURING, and AFTER my procedure. I agree to these being stored with my case file and used for insurance and promotional purposes.
MEDICAL FORM
Gender * : MaleFemale
Have you had this treatment done before? * YesNo
If you answered YES please answer the following questions.
How long ago was your treatment?:
What procedure did you receive?:
At what clinic did you receive the treatment?:
Were you happy with the result? If not please explain WHY?:
MEDICAL CONDITIONS
Please answer YES or NO to the following questions. These details will then be discussed (in confidence) with your consultant.
Do you feel fit and well, and able to have this treatment done today? * : YesNo
Are you over the age of 18? * : YesNo
Are you currently pregnant or breastfeeding? * : YesNo
Are you under the influence of alcohol or drugs? * : YesNo
Do you have any allergies or have you experienced any allergic reactions to medicine? * : YesNo
If you answered YES please list:
Are you currently taking any medication? Please note that some medications will prevent us from carrying out a treatment so please list below if applicable * : YesNo
Are you currently under any hospital care? * : YesNo
If you answered YES please give further details * :
Are you currently taking any of the following prescribed medications; steroids, antabuse, cortisone cream or retinol? * : YesNo
If you answered YES please give further details:
Do you have or are you planning to have any injectable, fillers or chemical peels? (Please note that botox should be at least 2 weeks before / after brows. After brows is preferable) * : YesNo
Do you have any imminent holiday plans? (You will be unable to go in the sun for a minimum of 3 weeks following this procedure) * : YesNo
If you answered YES please provide the date when you go on holiday?:
Do you suffer from epilepsy? * : YesNo
Do you knowingly suffer from any infectious diseases? * : YesNo
Do you suffer from high or low blood pressure? * : YesNo
Do you suffer from diabetes? * : YesNo
Do you have any respiratory problems? * : YesNo
Do you suffer from dizziness or fainting attacks? * : YesNo
Do you suffer from HIV/AIDS? * : YesNo
Do you suffer from heart problems? * : YesNo
Do you suffer from hepatitis? * : YesNo
Do you suffer from hemophilia * ? YesNo
Do you suffer from skin problems? (i.e. eczema, psoriasis on or around the treatment area) * : YesNo
Do you suffer from keloid scarring * ? YesNo
If you suffer from any of the above it is important that you notify your consultant who can take the necessary precaution to ensure you receive the best treatment to avoid any risks to your health.
I understand the importance of my accurate and complete medical history. I understand that withholding any medical information may be detrimental to my health and safety during and after the procedure. I understand that if there is any change in my medial history that it is my responsibility to inform my consultant.
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