Elite Beauty Essentials

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Elite Beauty Essentials"

Transcription

1 Elite Beauty Essentials P E R M A N E N T M A K E U P W I L L N O T B E PERFORMED IF YOU ARE PREGNANT, NURSING or TRYING!!! NO EXCEPTIONS! If you are late for your appointment you will be rescheduled. Please arrive 15 min. early to fill out paperwork. Thank you for your understanding. IMPORTANT INFORMATION - PLEASE READ- MEDICATION WHEN YOU COME IN THE OFFICE, YOU WILL HAVE TO FILL OUT NEW CLIENT PAPERWORK. IF YOU ARRIVE, AND I KNOW YOU HAVE TAKEN MOOD ALTERING MEDICATIONS OR THERE-LIKE I WILL CANCEL YOUR APPOINTMENT. IF YOU ARE TAKING LEGALLY PRESCRIBED MEDICINES, PLEASE TAKE THEM AFTER YOUR PROCEDURE AS YOU NEED TO BE IN A CLEAR STATE OF MIND. NO EXCEPTIONS If you are required to be on antibiotics prior to any type of procedure, a Dr's clearance letter will be required. If you show up to the appt. w/o this clearance, your appointment will be canceled and rescheduled to another available day. You will forfeit your deposit and be required to place a new deposit for the new appointment. Medications you Should NOT take before procedure. (ie: Prozac, Xanax, Valium or there-like) YOU WILL BE CANCELED AND RESCHEDULED!

2 PRE APPOINTMENT CARE AND WARNINGS If you like, you come to your appointment with your eyebrows penciled the way you like them. Bring your colored pencil of choice. Previously done eyebrows may take 1-3 treatments to achieve the desired result. Scar tissue in the brow area of eyebrows done multiple times WILL require additional procedures and fees will apply IF YOU TAN: Y0U CANNOT HAVE A TAN ON YOUR FACE AT TIME OF APPOINTMENT OR YOU WILL BE RESCHEDULED. PIGMENTS WILL HEAL DARKER IN TAN SKIN. TAN SKIN BLEEDS THEREFORE PIGMENT WILL NOT TAKE AND WILL LOOK BLURRED. EVEN AFTER THEY ARE HEALED, SUN EXPOSURE WILL CAUSE THE TATTOO TO DARKEN AS YOUR SKIN DARKENS AND THIS CANNOT BE LIGHTENED. IT IS RECOMMENDED TO KEEP OUT OF THE SUN. IF YOU TWEEZE: DO NOT TWEEZE, WAX OR THREAD FOR 7 DAYS PRIOR If you get your eyebrows waxed or tinted, please have this done at least 7 days prior to your scheduled procedure. It is recommended to wait at least 10 days to have them waxed & 30 days for tinting after the procedure.

3 IF YOU HAVE BOTOX: Botox should be performed 3 weeks before or 3 weeks after the procedure. FACIALS: No chemical peels or lasers 60 days prior and must wait 60 days after (avoiding the forehead is recommended). IF YOU DO FREQUENT PEELS AND LASERS THE BROWS WILL FADE QUICKER DUE TO THE CHEMICALS TRAVELING UNDER THE SKIN. FACIALS - CONTINUED: Retinols/ Retin-A's, other anti-aging creams or serums containing acids WILL fade your permanent makeup prematurely EVEN AFTER IT IS HEALED. You must be OFF all Retinols / Retina-A 30 days prior to appt. If not the area will bleed and pigment will not heal properly. If you resume the Retinols, your brows WILL fade quickly due to the chemicals in the creams. IF YOU BLEACH: If you bleach your eyebrows, it is recommended NOT to have this procedure done. The chemicals WILL bleach the hair & the pigment as well. PREVIOUS PMU: If you have had Permanent Makeup previously done and fail to tell us, E.B.E WILL refuse service and your deposit will be forfeited.

4 OTHER Precautions: NO LASH/BROW GROWTH SERUMS ON BROWS AT ALL 60 DAYS PRIOR AND IT NOT RECOMMENDED FOR USE ON THE BROWS AT ALL AFTERWARDS Please forgive me but i will not work on a client : If there are any blemishes, pimples, active cold sores, irritation of the skin of any kind, moles, bruises or other skin imperfections IN or AROUND the area of the procedure. Elite Beauty Essentials WILL NOT be able to do the procedure until the blemish or area of concern are completely healed or the mole is removed and healed. If you run your finger through your brows and there is a bump, E.B.E WILL NOT do the procedure. ADVICE : You ARE NOT a good candidate if you have LARGE pores or Oily/Severely Oily Skin, your results WILL appear softer/solid or powdered looking.

5 General Rules for ALL Procedures EXERCISE If you work out regularly (5-7 days a week), your eyebrows WILL fade very fast due to the production of salt/sweat. Salt is used to remove permanent makeup. Appointments will not be moved earlier if you have premature fading due to lifestyle. They WILL appear more powdered or blurred under the skin as well. If you are not ok with this, then you should not have the procedure done. E.B.E reserves the right to refuse future services if she feels the results wont be to the clients satisfaction. TAN(ADDENDUM) YOU CANNOT HAVE A TAN 30 DAYS BEFORE & ABSOLUTELY NO SUN 30 DAYS AFTER (This means you cannot go out in sun with a hat and glasses on, this means no SUN or HEAT FOR 30 AFTER at all. If you resume tanning, the results will fade quickly, heal darker, fade super fast or not retain at all. E.B.E will not see you any sooner than your routine scheduled appt. If you ruin the results by going out in the sun too soon, E.B.E may not be able to work on you in the future. E.B.E WILL CANCEL YOUR APPT. IF YOU SHOW UP WITH A TAN (A tan to E.B.E s standards). TAN SKIN BLEEDS, HEALS POORLY AND COLORS WILL NOT HEAL PROPERLY. NO EXCEPTIONS.

IF YOU GET FILLERS, THEY SHOULD BE DONE 6 WEEKS PRIOR TO YOUR SCHEDULED PROCEDURE OR DONE 6 WEEKS AFTER THE PROCEDURE.

IF YOU GET FILLERS, THEY SHOULD BE DONE 6 WEEKS PRIOR TO YOUR SCHEDULED PROCEDURE OR DONE 6 WEEKS AFTER THE PROCEDURE. If you have had Permanent Makeup previously done and fail to tell us, Elena reserves the right to refuse service and may recommend removal Her signature hair stroke technique will not work over dark, solid,

More information

Contraindications Pre and Post Instructions

Contraindications Pre and Post Instructions Contraindications Pre and Post Instructions **VERY IMPORTANT---PLEASE READ** **It is very important you follow these rules as medical conditions can affect the outcome of your eyebrows. Please notify me

More information

ibrow Studio Client Information Packet

ibrow Studio Client Information Packet ibrow Studio Client Information Packet Thank you so much for trusting me with your beautiful face! Prior to booking an appointment, we ask that all ibrow Studio clients read and review the information

More information

Permanent Makeup Before & Aftercare Instructions. Permanent Makeup by Michelle Louise

Permanent Makeup Before & Aftercare Instructions. Permanent Makeup by Michelle Louise Permanent Makeup by Michelle Louise Permanent Makeup Before & Aftercare Instructions IMPORTANT INFORMATION This document contains important information. Please read it carefully. www.michelle-lousie.com

More information

GENERAL CONSENT FORM

GENERAL CONSENT FORM GENERAL CONSENT FORM Please read this form fully, initial each line item and sign at the end. If you are unsure about a detail of the form, please speak to your practitioner. If unforeseen conditions arise

More information

VICKI HENKE MICROBLADING PERMANENT COSMETICS. What to expect in the healing process for all brow enhancement/permanent makeup procedures.

VICKI HENKE MICROBLADING PERMANENT COSMETICS. What to expect in the healing process for all brow enhancement/permanent makeup procedures. MICROBLADING/MANUAL PERMANENT MAKEUP TREATMENT BEFORE & AFTER CARE INSTURCTIONS What to expect in the healing process for all brow enhancement/permanent makeup procedures. WHILE YOUR SKIN HEALS, BE PREPARED

More information

Micropigmentation (Semi-Permanent Makeup) Informed Consent

Micropigmentation (Semi-Permanent Makeup) Informed Consent Micropigmentation (Semi-Permanent Makeup) Informed Consent The nature and method of the proposed semi-permanent makeup (cosmetic tattoo) procedure has been explained to me as having the usual risks inherent

More information

Touch Up-Color Refresh Policy

Touch Up-Color Refresh Policy Touch Up-Color Refresh Policy All Full Price New Procedures clients receive one Follow up visit for $50 with your initial price per procedure. You must wait at least 30 days before you can be touched up.

More information

Hair To Bare South. Client Name: Date:

Hair To Bare South. Client Name: Date: Hair To Bare South Client Name: Date: I authorize Rachelle Stokes (Hair To Bare South) to perform the treatments. The purpose of these treatments is to diminish or remove unwanted hair. The quantity of

More information

Informed Consent For Facial Rejuvenation/Collagen Remodel

Informed Consent For Facial Rejuvenation/Collagen Remodel Informed Consent For Facial Rejuvenation/Collagen Remodel Client s name: Date: I authorize SilkySkin Laser Centers to perform the laser procedure. You will be treated with the Cynosure Elite TM laser,

More information

Client Medical History Form

Client Medical History Form Client Medical History Form Date Birth Date Age DL or ID# Name: Address City State Zip Phone Email Emergency contact person Phone Do you presently have or previously had any of the following: (Circle yes

More information

Client Medical History Form

Client Medical History Form Client Medical History Form Date Birthdate Name Address Phone Email Emergency Contact Person Phone Do you have or previously had any of the following: (Circle YES or NO) YES NO History of MRSA YES NO Botox

More information

INFORMED CHEMICAL PEEL CONSENT. 1. I authorize the chemical peel listed above, to my face and / or neck, chest and hands.

INFORMED CHEMICAL PEEL CONSENT. 1. I authorize the chemical peel listed above, to my face and / or neck, chest and hands. INFORMED CHEMICAL PEEL CONSENT 1. I authorize the chemical peel listed above, to my face and / or neck, chest and hands. 2. Depending on the chemical peel site, there may be redness and/or irritation and

More information

Beautiful You LLC. Laser Hair Removal Pre/Post Treatment Care

Beautiful You LLC. Laser Hair Removal Pre/Post Treatment Care Beautiful You LLC Laser Hair Removal Pre/Post Treatment Care Pre-Treatment Instructions Avoid deep tanning, including tanning beds and tanning creams, 2 weeks before and 1 week after treatment. If you

More information

Consent and Release Agreement

Consent and Release Agreement Consent and Release Agreement This form is designed to give information needed to make an informed choice of whether or not to undergo a 3D Eyebrow Embroidery Semi-permanent make up application. If you

More information

Pre Treatment Advice and Procedures

Pre Treatment Advice and Procedures Pre Treatment Advice and Procedures 1. Since delicate skin or sensitive areas may swell slightly, or redden, it is advised not to make social plans for the same day. Lip liner may appear crusty for up

More information

APPOINTMENT POLICY. Dear Client, Your time is very important to me and I appreciate that you equally respect mine. Below is our appointment policy.

APPOINTMENT POLICY. Dear Client, Your time is very important to me and I appreciate that you equally respect mine. Below is our appointment policy. APPOINTMENT POLICY Dear Client, Your time is very important to me and I appreciate that you equally respect mine. Below is our appointment policy. 1. One consultation visit is free of charge. A 24 hour

More information

Menter Cosmetic Institute 3900 Junius Street, Suite 105 by Texas Dermatology Associates Dallas TX, (972) Ext. 255

Menter Cosmetic Institute 3900 Junius Street, Suite 105 by Texas Dermatology Associates Dallas TX, (972) Ext. 255 PRECAUTIONS TO CONSIDER BEFORE FRAXEL TREATMENTS SIX TO TWELVE MONTHS BEFORE TREATMENT: Stop use of Accutane TWO WEEKS BEFORE TREATMENT: Stop use of all Retinols - Retin-A, Tazorac, anti-aging products

More information

Microblading Consent and Release Agreement

Microblading Consent and Release Agreement Microblading Consent and Release Agreement This form is designed to give information needed to make an informed choice of whether or not to undergo a Microblading semi-permanent make up application. If

More information

Client Medical History Form

Client Medical History Form Client Medical History Form Today s Date: Birthday: / / Age Name: TXID# Address: Phone: Email: Tattoo Area: Eye Brows (Micro-Blading) Brand of Ink: Bio Touch Pure / / / Emergency Contact: Phone: Do you

More information

East Hill Medical Group

East Hill Medical Group Name: of Birth: Address: City: State: Zip: Home Tel. #: Cell #: Employer: Occupation: Emergency Contact: Relationship: Phone: Email: How Referred: Parents Ethnic Background: Previous Treatments Year: Area(s):

More information

MICROFEATHERING. Photo by Robin Black

MICROFEATHERING. Photo by Robin Black Photo by Robin Black Microfeathering is Kristie s signature Microblading Concept and is performed by depositing pigment superficially into the epidermis of the eyebrow. After numbing the area with a topical

More information

Date: Date of Birth: Gender: Male Female. City: State: Zip: Caucasion a African-American Hispanic Asian East Indian American Indian

Date: Date of Birth: Gender: Male Female. City: State: Zip: Caucasion a African-American Hispanic Asian East Indian American Indian Contact Information: Date: Date of Birth: Gender: Male Female Name: Address: City: State: Zip: Home Phone: Work/Day Phone: Cell: Email: Emergency Contact: Emergency Contact Phone: Medical Background Ethnic

More information

Newport Cosmetic Center

Newport Cosmetic Center Shirin Afrasiabi, M.D, Inc. 2301 Newport Blvd, Costa Mesa, Ca 92627 (949) 548-5700 Appointment: Initial. We require a valid Credit Card at the time of booking to secure your appointment Cancellation and

More information

CLIENT CONSULTATION AND MEDICAL HEALTH FORM FOR PERMANENT MAKEUP

CLIENT CONSULTATION AND MEDICAL HEALTH FORM FOR PERMANENT MAKEUP CLIENT CONSULTATION AND MEDICAL HEALTH FORM FOR PERMANENT MAKEUP Name: DOB: Best Phone Contact: Address: Email: List any medications you have been taking in the past 6 months: Have you received chemotherapy

More information

Pre and Post Procedure Information for Cosmetic Laser Skin Resurfacing with the DOT laser. James A. Rieger, MD (316)

Pre and Post Procedure Information for Cosmetic Laser Skin Resurfacing with the DOT laser. James A. Rieger, MD (316) Pre and Post Procedure Information for Cosmetic Laser Skin Resurfacing with the DOT laser James A. Rieger, MD (316)-652-9333 You have scheduled a delicate cosmetic laser procedure. The following information

More information

3-DAY INTENSIVE MICROBLADING COURSE. Maja Lipovec & Bojan Jončič INTERNATIONAL MICROBLADING TRAINNING TEAM

3-DAY INTENSIVE MICROBLADING COURSE. Maja Lipovec & Bojan Jončič INTERNATIONAL MICROBLADING TRAINNING TEAM 3-DAY INTENSIVE MICROBLADING COURSE Maja Lipovec & Bojan Jončič INTERNATIONAL MICROBLADING TRAINNING TEAM About this course Microblading is also refered to as eyebrow tattoos, eyebrow feathering or embroidery

More information

Informed Consent for Light Energy Tattoo Removal

Informed Consent for Light Energy Tattoo Removal Dr. Joseph G. Protain 813 Kentwood Dr. Boardman, OH 44512 (330)953-3515 Informed Consent for Light Energy Tattoo Removal Customer s name: Date: I, consent to and authorize and members of his/her staff

More information

Client Intake Form. Name: Date: Address: City: ST: Zip: Phone:

Client Intake Form. Name: Date: Address: City: ST: Zip:   Phone: Client Intake Form Name: Date: Last First Address: City: ST: Zip: Email: Phone: How did you hear about Skin Renew Day Spa? What are your main concerns? How long have you been experiencing your current

More information

CLEAR TOE INTAKE INFORMATION

CLEAR TOE INTAKE INFORMATION CLEAR TOE INTAKE INFORMATION Name: Today s Date: Last First MI Street address: City: State: Zip: Date of birth: Age: Sex: Female Male Home Phone: Cell Phone: Leave messages at: Home Cell Other: Email address:

More information

Chameleon Medical Spa NEW CLIENT HISTORY

Chameleon Medical Spa NEW CLIENT HISTORY NEW CLIENT HISTORY This information will allow your professional skincare specialist to provide the optimum products and services. First Name: Last Name: Date: Birth date: Address: City: State:_ Zip code:

More information

Permanent Cosmetics Contraindications

Permanent Cosmetics Contraindications Permanent Cosmetics Contraindications under 18 years of age diabetes pregnant or lactating women glaucoma skin diseases such as psoriasis, eczema and undiagnosed rashes or blisters on the site that is

More information

PLEASE SEE OUR PRICE LIST OF SERVICES BELOW. NOTE ALL PRICES ARE INDICATIVE AND SUBJECT TO CONSULTATION.

PLEASE SEE OUR PRICE LIST OF SERVICES BELOW. NOTE ALL PRICES ARE INDICATIVE AND SUBJECT TO CONSULTATION. FACIAL RENU PRICELIST 2019 PLEASE SEE OUR PRICE LIST OF SERVICES BELOW. NOTE ALL PRICES ARE INDICATIVE AND SUBJECT TO CONSULTATION. CONSULTATION FACIAL SKIN ANALYSIS 30 MINS We use our Facial Skin Analysis

More information

Brow and Beauty Bar - Permanent Makeup

Brow and Beauty Bar - Permanent Makeup General Consent and Procedure Permit Clients Full Name Mr/Mrs/Miss/Ms Address e-mail I hereby authorize Erin Exline to perform upon myself permanent cosmetic enhancement. If any unforeseen condition arises

More information

Welcome to Medspa 1064, Connecticut s Premier Center for Cosmetic Laser Medicine

Welcome to Medspa 1064, Connecticut s Premier Center for Cosmetic Laser Medicine MedSpa 1064 Suites at Somerset Square 140 Glastonbury Blvd. Glastonbury, CT 06033 860.657.1064 Welcome to Medspa 1064, Connecticut s Premier Center for Cosmetic Laser Medicine This form is to introduce

More information

CLIENT CONSULTATION AND MEDICAL HEALTH FORM FOR MICROBLADING

CLIENT CONSULTATION AND MEDICAL HEALTH FORM FOR MICROBLADING CLIENT CONSULTATION AND MEDICAL HEALTH FORM FOR MICROBLADING Name: DOB: Best Phone Contact: Address: Email: List any medications you have been taking in the past 6 months: Have you received chemotherapy

More information

NEW CLIENT FORM. Address: City: State: Zip: FITZPATRICK CLASSIFICATION SYSTEM: Please select the skin type seems to best describe your skin

NEW CLIENT FORM. Address: City: State: Zip: FITZPATRICK CLASSIFICATION SYSTEM: Please select the skin type seems to best describe your skin OREGON LASER & WELLNESS CENTER 4370 SE KING ROAD SUITE 105 MILWAUKIE, OR 97222 PHONE: 503 305 7704 or 971 263 7679 Date: Name: NEW CLIENT FORM Address: City: State: Zip: Email: Home Phone: Work Phone:

More information

Pre-Treatment Advice and Procedures

Pre-Treatment Advice and Procedures 1 Client copy Pre-Treatment Advice and Procedures Since delicate skin or sensitive areas may swell slightly, or redden, it is advised not to make social plans for the same day. Lip liner may appear "crusty"

More information

513 Maple Ave West, Vienna, VA

513 Maple Ave West, Vienna, VA CLIENT INFORMATION AND CONSENT FORM: SKIN CARE Name Date of Consultation Address City State Zip Home phone ( ) Cellular phone ( ) E-mail Date of birth Emergency contact and telephone number How did you

More information

STATEMENT OF CONSENT AND RECITALS: Please read and initial all lines. Signed

STATEMENT OF CONSENT AND RECITALS: Please read and initial all lines. Signed STATEMENT OF CONSENT AND RECITALS: Please read and initial all lines Aftercare instructions have been explained to me and a written copy will be given to me to retain in my possession, which I will follow

More information

Retreat is your Retreat

Retreat is your Retreat Retreat is your Retreat A warm welcome awaits you at R Retreat. R Retreat is filled with passion and scents to lift your spirit. R luxurious treatments have been consciously chosen to give real results

More information

Breakout Session B: The Facts and Myths of Microblading. Rose Marie Beauchemin

Breakout Session B: The Facts and Myths of Microblading. Rose Marie Beauchemin 24TH Annual Meeting Breakout Session B: The Facts and Myths of Microblading Rose Marie Beauchemin Upon completion of this presentation, the participants will self-report an increase in knowledge about:

More information

CLIENT CONSULTATION AND MEDICAL HEALTH FORM FOR MICROBLADING

CLIENT CONSULTATION AND MEDICAL HEALTH FORM FOR MICROBLADING CLIENT CONSULTATION AND MEDICAL HEALTH FORM FOR MICROBLADING Name: DOB: Phone : Address: Email: List any medications you have been taking in the past 6 months: Have you received chemotherapy or radiation

More information

PREPARATION AND RISKS. Be sure to read through all the information I have provided and call with any questions at (608)

PREPARATION AND RISKS. Be sure to read through all the information I have provided and call with any questions at (608) PREPARATION AND RISKS Be sure to read through all the information I have provided and call with any questions at (608) 772-0190 The following is information I d like to share to help prepare you better

More information

IPL CONSULTATION AND LIABILITY DOCUMENTATION

IPL CONSULTATION AND LIABILITY DOCUMENTATION Name...... Address:... Date of Birth:... Suburb:... Postcode:... Home Phone:... Mobile:... Email Address:... How did you hear about us?... Contact in case of emergency:... Place a tick in the areas of

More information

Welcome to Bella! Give the Gift of Bella. A few tips to prepare you for your first visit: Gift Certificates are just $100 for a $150 value!

Welcome to Bella! Give the Gift of Bella. A few tips to prepare you for your first visit: Gift Certificates are just $100 for a $150 value! Welcome to Bella! We are glad to have you as our guest. We encourage you to visit our website to see all of the exciting new laser and skincare treatments that we offer. Please be aware of our 24 hour

More information

LUXE Beauty Ink Permanent Cosmetic Tattoo Artistry by Lynne SW Greenburg Rd., Suite 113 Tigard, OR

LUXE Beauty Ink Permanent Cosmetic Tattoo Artistry by Lynne SW Greenburg Rd., Suite 113 Tigard, OR LUXE Beauty Ink 11825 SW Greenburg Rd., Suite 113 Tigard, OR 97223 COSMETIC TATTOO PRE-TREATMENT INSTRUCTIONS If possible, do not take aspirin or other blood thinners 5-7 days before the procedure to prevent

More information

Pre & Post (BBL)Laser Hair Removal Treatment Instructions

Pre & Post (BBL)Laser Hair Removal Treatment Instructions Pre & Post (BBL)Laser Hair Removal Treatment Instructions Pre-Treatment Recommendations: Apply SPF 30 (or higher) sunblock at all times on areas to be treated that are exposed to any sun. Shave the area

More information

VENUS BEAUTY LOUNGE. Before Your Microblading Session

VENUS BEAUTY LOUNGE. Before Your Microblading Session Great microblading is not a beautiful result directly after treatment. It is a crisp, natural, long-lasting result once healed. Aleksandra Maniuse-Founder Deluxe Brows Microblading is a manual technique

More information

Intake Form Chemical Peels, Microdermabrasion, and Facials

Intake Form Chemical Peels, Microdermabrasion, and Facials Intake Form Chemical Peels, Microdermabrasion, and Facials Name: Today s Date: Last First MI Street address: City: State: Zip: Date of birth: Age: Sex: 0 Female 0 Male Home Phone: Cell Phone: Leave messages

More information

Eyelash Extension Consultation Form

Eyelash Extension Consultation Form Eyelash Extension Consultation Form Date Name Address City State Zip Cell # Is it ok to text this phone? Yes / No *we use text messaging as a way to send appointment confirmations Birthday: E-Mail Address

More information

Permanent Makeup Intake Form

Permanent Makeup Intake Form Permanent Makeup Intake Form Artist Information (the Artist ): Chrystal Ladouceur 1530 McTavish Road, North Saanich, B.C., V8L 5T3 Client Information (the Client ): First Name Email Mobile Phone Address

More information

Top 10 Frequently Ask Questions

Top 10 Frequently Ask Questions Cosmopolitan, August, 2005 Top 10 Frequently Ask Questions By Mary The Q1. My face is often get annoyed by poxes, I ve tried many methods to cure them but with no success. What shall I do? Many things

More information

AREA OF BODY TATTOO IS SITUATED?

AREA OF BODY TATTOO IS SITUATED? CLIENT CONSULTATION LASER TATTOO REMOVAL FORM Address: Date of Birth: Suburb: State: Postcode: Telephone: Work: Mobile Home: Other: Email Address: How did you hear about us? Tattoo Removal Colours in tattoo

More information

Microblading Consent Form Client Medical History: Date Birthdate Age Name Form of Id # Address

Microblading Consent Form Client Medical History: Date Birthdate Age Name Form of Id # Address Microblading Consent Form Client Medical History: Date Birthdate Age Name Form of Id # Address Phone Email Emergency Contact Person Phone Do you have or previously had any of the following: (Circle YES

More information

GENERAL CONSENT AND PROCEDURE PERMIT FORM

GENERAL CONSENT AND PROCEDURE PERMIT FORM GENERAL CONSENT AND PROCEDURE PERMIT FORM 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 therapist. If unforeseen condition

More information

Forename Surname... SOPRANO ICE SHR LASER CONSULTATION FORM

Forename Surname... SOPRANO ICE SHR LASER CONSULTATION FORM Forename Surname... SOPRANO ICE SHR LASER CONSULTATION FORM 1 SOPRANO ICE SHR PERSONAL INFORMATION Gender: Male/Female Date of birth.age. Home address..postcode.. Telephone..Mobile.. Email address.. GP

More information

Everything you need to know about TATTOO REMOVAL

Everything you need to know about TATTOO REMOVAL Everything you need to know about TATTOO REMOVAL LASER TATTOO REDUCTION Tattoos are meant to last forever, but sometimes it would be good if they didn t! Whether you wish to erase a mistake or fade a tattoo

More information

Client Information & Health History

Client Information & Health History Client Information & Health History Name: Address: City: State: Zip Code: Cell#: Work#: Home#: Email: Preferred method of contact: email cell# work# home# Date of Birth: Occupation: How did you hear about

More information

Consultation Form: Coffeeberry Peel

Consultation Form: Coffeeberry Peel Consultation Form: Coffeeberry Peel NAME: ADDRESS: TELEPHONE NUMBER: DATE OF BIRTH: EMERGENCY CONTACT: EMAIL ADDRESS: OCCUPATION: DOCTORS NAME/SURGERY: We aim to ensure clients have the best possible advice

More information

Areas of Concern. Patient s Name Last First Date

Areas of Concern. Patient s Name Last First Date Areas of Concern What are your main concerns for today s visit? Please check the problem areas that concern you. Include anything you wish to discuss, even if it is not the main reason for your visit.

More information

Medication Name Reason Taken Dosage Last Date Taken

Medication Name Reason Taken Dosage Last Date Taken CLIENT HISTORY FORM Print Name Location of Service: Email Birth Date Age Gender @ Female Address City State / Male Emergency Contact Name and Number Home Phone ( ) Cell Phone ( ) Today s Procedure Description:

More information

Maya Med Spa 6330 Broadway Blvd. Suite B, Garland, TX Name: Date of birth: Address: Pharmacy of your choice:

Maya Med Spa 6330 Broadway Blvd. Suite B, Garland, TX Name: Date of birth: Address: Pharmacy of your choice: Client Consultation Name: Date of birth: Address: Home Phone: Cell Phone: Business Phone: E-mail address: Married: Yes No If yes, anniversary date: Employer: Occupation: Pharmacy of your choice: Does your

More information

Pre Wax Prep. PLEASE DON T SHAVE! You re coming in for a waxing service, and if your hair is

Pre Wax Prep. PLEASE DON T SHAVE! You re coming in for a waxing service, and if your hair is Pre Wax Prep Please bring a list of medications that you are taking to your appointment, and keep me appraised of any changes to your medications during subsequent appointments. There are several medications

More information

Pre-Treatment Advice and Procedures

Pre-Treatment Advice and Procedures Pre-Treatment Advice and Procedures 1) Since delicate skin or sensitive areas may swell slightly, or redden, it is advised not to make social plans for the same day. Lip liner may appear crusty for up

More information

More Than Just A Beauty Salon. t: Prestbury Road, Cheltenham GL52 2PW AbsoluteBeautyCheltenham

More Than Just A Beauty Salon. t: Prestbury Road, Cheltenham GL52 2PW   AbsoluteBeautyCheltenham More Than Just A Beauty Salon t: 01242 579600 10 Prestbury Road, Cheltenham GL52 2PW www.absolute-beauty.com AbsoluteBeautyCheltenham for anyone being treated for cancer The therapists give their time

More information

Skin Needling $200 Epi Blading $110 Peel It $75 30 Mins Express Hydradermabrasion $65 30 Mins Deluxe Hydradermabrasion $118 60mins

Skin Needling $200 Epi Blading $110 Peel It $75 30 Mins Express Hydradermabrasion $65 30 Mins Deluxe Hydradermabrasion $118 60mins FACE Skin Needling $200 Stimulates the production of your own collagen to create a more rejuvenated and healthier skin. Great for reducing acne scaring, stretch marks, fine lines, pigmentation, enlarged

More information

CLINICAL FORMS AND CHARTING

CLINICAL FORMS AND CHARTING CLINICAL FORMS AND CHARTING CLINICAL Lira Clinical forms to help you chart, analyze and evaluate your client for a successful skin care plan. 110 110 NAME TREAMENT DATE PROFESSIONAL RESURFACING TREATMENT

More information

Dukes Walk The Mall Maidstone Kent ME156AT

Dukes Walk The Mall Maidstone Kent ME156AT 01622 688533 243-244 Dukes Walk The Mall Maidstone Kent ME156AT Email : info-panachebeauty@mail.com Web : panachebeautymaidstone.co.uk FIND US ON : Facebook/Instagram CND Shellac / Jessica GELeration

More information

Microblading. More information can be found at the Society of Permanent Cosmetic Professionals.

Microblading. More information can be found at  the Society of Permanent Cosmetic Professionals. Microblading (eyebrow tattooing, eyebrow embroidery, microstroking, micropigmentation, dermal implantation, permanent cosmetics, feathering eyebrows cosmetic tattooing) Any time color is placed into the

More information

CLIENT CONSULTATION AND MEDICAL HEALTH FORM FOR MICROBLADING

CLIENT CONSULTATION AND MEDICAL HEALTH FORM FOR MICROBLADING CLIENT CONSULTATION AND MEDICAL HEALTH FORM FOR MICROBLADING Name: DOB: Best Phone Contact: Address: Email: List any medications you have been taking in the past 6 months: Age Have you received chemotherapy

More information

5504 Backlick Road Springfield, Virginia

5504 Backlick Road Springfield, Virginia Name: Address: Phone: City: Zip Code: Cell: Phone: Text Cell Phone email How did you hear about us: General Health State: Contact me by 1. Rate your level of stress: (5 = highest, 1= lowest) 5 4 3 2 1

More information

Patient information. Nipple-areola Tattoo. Breast Services Directorate PIF 1049 V3

Patient information. Nipple-areola Tattoo. Breast Services Directorate PIF 1049 V3 Patient information Nipple-areola Tattoo Breast Services Directorate PIF 1049 V3 What is a nipple-areola tattoo? Nipple tattoo is the implantation of small amounts of pigment (dye) into the skin to create

More information

New Patient Registration

New Patient Registration New Patient Registration Today s Date: Social Security Number: Name: Last First MIddle How do you like to be addressed: Date of Birth: Address: Street City State Zip Email Address: Preferred Contact Number:

More information

NEW CLIENT GENERAL INFORMATION FORM

NEW CLIENT GENERAL INFORMATION FORM NEW CLIENT GENERAL INFORMATION FORM First Name: Last Name: Email: Date of Birth: Occupation: Home Phone: Cell Phone: Carrier: Gender: Female Male Preferred Staff Gender: Female Male Preferred Staff Member:

More information

Imbue Aesthetics & Wellness PATIENT REGISTRATION FORM

Imbue Aesthetics & Wellness PATIENT REGISTRATION FORM Today's Date Legal Name Marital Status Sex DOB Age Mailing Address Preferred Phone Number Email Do we have your permission to add you to our email list to receive newsletters and promotions? YES NO Emergency

More information

Patient Information Leaflet. Dermal Filler

Patient Information Leaflet. Dermal Filler Patient Information Leaflet Dermal Filler When considering treatment with dermal fillers we want you to have a safe treatment. Some risks are unavoidable and out of your control. The following information

More information

HEALTH HISTORY INFORMATION

HEALTH HISTORY INFORMATION HEALTH HISTORY INFORMATION Name: Today s Date: Last First MI Street address: City: State: Zip: Date of birth: Age: Sex: Female Male Home Phone: Cell Phone: Leave messages at: Home Cell Other: Email address:

More information

Serenity Now. September Pedicure Special Apple Pedicure BOTOX NIGHT, TUESDAY, NOVEMBER 1ST

Serenity Now. September Pedicure Special Apple Pedicure BOTOX NIGHT, TUESDAY, NOVEMBER 1ST Serenity Now September Pedicure Special Apple Pedicure Includes Complimentary Beverage $65 Express add on Treatments: Glycolic callus eliminator $20 Hot Stones $15 Warm Paraffin booties $15 Say hello to

More information

Thinking of Permanent Cosmetics?

Thinking of Permanent Cosmetics? Thinking of Permanent Cosmetics? Here are guidelines to help you have a great experience. People from all walks of life enjoy the benefits of permanent makeup. Professional women, athletes, those with

More information

COSMETIC LASER AND AESTHETICS CENTER

COSMETIC LASER AND AESTHETICS CENTER COSMETIC LASER AND AESTHETICS CENTER PERSONAL INFORMATION Please complete the following: Date: Name: Date of Birth: Home Address: City: State: Zip: Home Telephone: ( ) Cell: ( ) Work Phone: ( ) Email This

More information

Client Information Sheet

Client Information Sheet Esthetic Laser Clinic 8381 Old Courthouse Road Suite 300 Vienna, VA 22182 (703) 288 0085 www.elaserclinic.com Client Information Sheet Last Name First Name: Address City State Zip Code D.O.B. (MM/DD/YY)

More information

GILDA INTERNATIONAL BEAUTY SCHOOL SALON TREATMENTS GÖTEBORG

GILDA INTERNATIONAL BEAUTY SCHOOL SALON TREATMENTS GÖTEBORG GILDA INTERNATIONAL BEAUTY SCHOOL SALON TREATMENTS GÖTEBORG PROFESSIONAL TREATMENTS WITH STUDENTS FROM GILDA SKOLAN All the time and price indications are including 5-15 minutes customer consultation.

More information

Personal Profile and Health History

Personal Profile and Health History --CAPITAL AESTHETICS Personal Profile and Health History Name: Home Phone: Address: Work Phone: City/State/Zip: Date of Birth: Age: Gender: M F Occupation: Email address: How did you hear about us? What

More information

Building 16, Store 1 Port Zante Basseterre, St. Kitts 00265

Building 16, Store 1 Port Zante Basseterre, St. Kitts 00265 M A N I C U R E Gentleman s Manicure - USD 40 Nails and cuticles are expertly shaped before hands and arms are massaged with a hydrating warm cream. Nails are then buffed to a clean finish. Renu Signature

More information

Consultation Form: AHA Chemical Peel

Consultation Form: AHA Chemical Peel Consultation Form: AHA Chemical Peel NAME: ADDRESS: TELEPHONE NUMBER: DATE OF BIRTH: EMERGENCY CONTACT: EMAIL ADDRESS: OCCUPATION: DOCTORS NAME/SURGERY: We aim to ensure clients have the best possible

More information

Laser Skin Resurfacing what to expect

Laser Skin Resurfacing what to expect Laser Skin Resurfacing what to expect Laser skin resurfacing is a treatment to reduce facial wrinkles and skin irregularities, such as blemishes or acne scars. The technique directs short, concentrated

More information

FACE & BODY REVIVAL PROUDLY PRESENTS OUR EXCLUSIVE MEMBERSHIP PROGRAM

FACE & BODY REVIVAL PROUDLY PRESENTS OUR EXCLUSIVE MEMBERSHIP PROGRAM How Does Microdermabration Work? This treatment is one of the latest breakthroughs in dermatology for all skin conditions, however microdermabrasion is not recommended for those who have active keloids,

More information

COSMETIC INTEREST QUESTIONNAIRE

COSMETIC INTEREST QUESTIONNAIRE COSMETIC INTEREST QUESTIONNAIRE Patient Name: Date: General appearance or products of interest to you (please check all that apply). Skin care consult Facial veins Neck elasticity Skin care products Facial

More information

CLIENT HISTORY. May we contact you at these numbers?

CLIENT HISTORY. May we contact you at these numbers? CLIENT HISTORY Name: Address: Home Phone: Cell Phone: Email Address: Date of Birth: Street City State Zip Business Phone: May we contact you at these numbers? Other ID: Referred by: Emergency Contact:

More information

Timeless Makeup, LLC

Timeless Makeup, LLC Timeless Makeup, LLC CLIENT REGISTRATION (Please complete all blanks) I. CLIENT INFORMATION Name Date Address City Zip Phone number Email address Type of work Ethnicity Date of birth What was your hair

More information

Q-switched Nd:YAG Carbon Laser Facial Further treatment possible using your Tattoo Removal Laser

Q-switched Nd:YAG Carbon Laser Facial Further treatment possible using your Tattoo Removal Laser Q-switched Nd:YAG Carbon Laser Facial Further treatment possible using your Tattoo Removal Laser Carbon Laser Peel plus a mild form of Skin Rejuvenation Course Topics What is a Carbon Laser Facial? How

More information

COLORADO AESTHETIC CENTER

COLORADO AESTHETIC CENTER COLORADO AESTHETIC CENTER 9320 Grand Cordera Parkway, Suite #250 Colorado Springs, CO 719.387.7800 Skin and Health Questionnaire Please answer the following questions thoroughly, as this provides a better

More information

Cosmetic Surgery: Eyelid Surgery (Blepharoplasty)

Cosmetic Surgery: Eyelid Surgery (Blepharoplasty) Cosmetic Surgery: Eyelid Surgery (Blepharoplasty) This is a guide for people who are considering an eyelid surgery. We advise that you talk to a plastic surgeon and only use this information as a guide

More information

Patient Contact Information. Name. Home Address. City State Zip

Patient Contact Information. Name. Home Address. City State Zip Patient Contact Information Name Home Phone Work Phone Cell Phone Home Address City State Zip E-Mail Date of Birth Emergency Contact Name and Phone Who Referred You To This Clinic? Would you like to receive

More information

CLIENTELE FORM. Name Date Address City State/Zip Referred by Phone Carrier

CLIENTELE FORM. Name  Date Address City State/Zip Referred by Phone Carrier Name Email Date Address City State/Zip Referred by Phone Carrier TO AOID COMPLICATIONS ANSWER THE FOLLOWING QUESTIONS, IF YES PLEASE EXPLAIN: Are you under the age of 18? Have you had any aspirin or blood

More information

With Beauty Guru S COTT S PENCER M ILLER

With Beauty Guru S COTT S PENCER M ILLER E S S E N T I A L S With Beauty Guru S COTT S PENCER M ILLER KINCARE S Women & Men Pro Skincare Beauty Tip! Dermatological Skincare + Daily Beauty Regiment + Facials Amazing Youthful Glowing Skin Use these

More information

HEALTH HISTORY. Name Date DOB Age. Home Phone Work Mobile Other

HEALTH HISTORY. Name Date DOB Age. Home Phone Work Mobile Other HEALTH HISTORY To ensure both the effectiveness and the safety of your treatment, please complete this health history as accurately as you can. PERSONAL INFORMATION Name _ Date DOB Age Address _ City State

More information

Tuesday Wednesday Thursday Friday Saturday Tuesday Wednesday

Tuesday Wednesday Thursday Friday Saturday Tuesday Wednesday Monday Closed Tuesday 9.15-6.00 Wednesday 9.15-6.00 Thursday 9.15-8.00 Friday 9.15-6.00 Saturday 9.15-4.00 Sunday Closed www.hblounge.com Monday Closed Tuesday 9.30-8.00 Wednesday 9.30-8.00 Thursday 9.30

More information

ENVIRON VITAMIN FACIALS

ENVIRON VITAMIN FACIALS All About You SKIN CARE & BODY CLINIC PRICE LIST 13 Crescent Way, Orpington, Kent BR6 9LP Book online www.orpingtonbeauty.co.uk 01689 861943 @allaboutyoukent www.facebook.com/all.about.you.orpington Therapist

More information