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 notice is required to reschedule a consultation appointment. If you fail to cancel/reschedule this appointment within this time frame, a $50 prepaid deposit is required to schedule another consultation. The $50 deposit will be applied toward any procedure of choice. 2. Please do not bring children to appointment(s). 3. After the consultation, a written price quote and a copy of these appointment policies are given. Clients are never pressured to schedule a procedure. In fact, all procedures should be carefully considered before scheduling them. 4. To reserve an appointment for a procedure, a deposit of $50 is required. The deposit will be applied toward the cost of the procedure. Pregnant or nursing women or anyone under the age of 18 will not be considered for tattooing. Please advise me now if any of these apply. 5. If an appointment must be rescheduled, a 24 hour notice is required in order to fill the opening in the schedule. The deposit will be applied toward the rescheduled appointment. However, if you fail to reschedule and not come at your appointed time, the deposit will not be refunded or reapplied and the full price of the procedure will be due with another procedure time deposit. Please understand that time is reserved for you and I need sufficient notice to fill my schedule. 6. The first visit of the process is the Saturation visit. The following visit is known as the Focus visit. As the names imply, the Saturation visit accomplishes the basic design and color saturation, and the Focus visit addresses perfection by focusing on balance, symmetry and detail of the healed result. There is no charge for the Focus visits as long as they are completed within 45 days of the previous visit. 7. A cancellation/rescheduling of a Focus visit is required 24 hours in advance. If you fail to reschedule and not come at your appointed time, the complimentary Focus visit is forfeited and a charge of $100 per follow up procedure will be required. 8. A Color Assessment appointment should be scheduled at the end of the first year and if a Touch-Up is needed, the charge is $250 per procedure. If, at the first year assessment, the touch-up is determined unnecessary, the charge for the second year touch-up is $450. The length of time one waits in between touch-up visits will determine all fees. 9. All color fades and your cosmetic tattoo will require maintenance. The amount of fading depends on several variables including medications and topical treatments, but is primarily due to sun (ultra-violet) exposure; therefore measures should be taken to protect your permanent cosmetics from the sun. I, the undersigned, received these appointment policies both verbally and in written form and I agree to comply with them. My signature is my consent to charge the aforementioned $50 non-refundable deposit against my credit card should I decide to reserve an appointment by phone. Name: Signature: Date:
PERMANENT COSMETICS PRE-PROCEDURE INFORMATION All permanent cosmetic procedures are multi-session processes. You are required to come back for at least one follow up visit before it can be determined that your work is complete. Follow up visits are scheduled at 2-6 week intervals. Be prepared for the color intensity of your procedure to be significantly sharper, brighter, or darker than what is expected for the final outcome. It will take time for this transition, based upon how quickly the outer layer of your skin exfoliates. While these tattooed colors may initially simulate the exact color and tone desired, they will not always remain a perfect match. Tattooed colors are constant, while your own skin color will vary depending on exposure to cold, heat, sun and circulatory changes. For example, if you tan your skin and had a scar camouflaged, your surrounding skin will be darker in appearance than the treated area. 1. Since delicate skin or sensitive areas may swell slightly or redden, some clients feel it best not to make any social plans for a day or two following any procedure. It is always best to avoid these procedures within months prior to important life events such as weddings. Procedures may take longer than expected to be complete under some circumstances. 2. Wear your normal makeup and bring your brow pencils to the office on the day of the procedure. 3. Any tweezing or waxing should be done at least 48 hours prior to the procedure; electrolysis no less than five days before. Do not resume any method of hair removal for at least two weeks. 4. Any eyelash or eyebrow tinting or eyelash curling should be done no sooner than 48 hours before, or two weeks after the procedure. 5. Do not wear contact lenses during or immediately following the eyeliner procedure. Remember to bring your glasses. You may resume wearing your contact lenses as soon as your eyes return to their pre-tattooed condition. 6. Following the eyeliner procedures, as a safety precaution, we recommend that you have someone available to accompany you or drive you home. 7. Refrain from the use of alcohol, aspirin, aspirin-containing medications, ibuprofen, or other bloodthinning medications for seven days before and two days after any procedure. Refrain from judgment-altering drugs for at least 24 hours prior to any procedure. No medication should ever be discontinued without first consulting your physician.
CONSENT TO APPLICATION OF PERMANENT COSMETIC PROCEDURE NAME AGE DOB DATE ADDRESS CITY STATE ZIP EMAIL CELL PH I am over the age of 18, am not under the influence of drugs or alcohol, am not pregnant or nursing and desire to receive the indicated permanent cosmetic procedure(s). The general nature of cosmetic tattooing as well as the specific procedure to be performed has been explained to me. X PROCEDURE(s): EXPECTED NO. OF VISITS REQUIRED: COST OF PROCEDURE(s): I have been informed of the nature, risks, and possible complications and consequences of permanent cosmetics (permanent skin pigmentation/cosmetic tattoo). I understand the permanent cosmetic procedure carries with it known and unknown complications and consequences associated with this type of cosmetic procedure, including but not limited to: infection, allergic reaction, scarring, inconsistent color, and spreading, fanning or fading of pigments. Corneal abrasions are a rare side effect, especially if I rub or scratch my eyes or apply contact lenses too soon after an eyeliner procedure. I understand the actual color of the pigment may be modified slightly, due to the tone and color of my skin. I fully understand this is a tattoo process and therefore not an exact science, but an art. I request the permanent cosmetic procedure(s), and accept the permanence of the procedure, acknowledge the likelihood of fading over time, as well as the possible complications and consequences of the said procedure(s). X I understand that if I have any skin treatments, laser hair removal, plastic surgery, or other skin altering procedures, it may result in adverse changes to my permanent cosmetics. I acknowledge some of these potential adverse changes may not be correctable. X I have received pre- and post procedure instructions and I will strictly adhere to such instructions. I understand that my failure to do so may jeopardize my chances for a successful procedure. I have disclosed all medications and/or drugs I am taking either prescription or non-prescription and their purpose or indications. I have disclosed any medical conditions that may affect the healing of my skin pigmentation. X I understand that the taking of before and after photographs of the said procedure(s) are a condition of such procedure(s). I certify I have read and initialed the above paragraphs and have had explained to my understanding this consent and procedure permit. I accept full responsibility for the decision to have this permanent cosmetic procedure(s) performed. CLIENT DATE TECHNICIAN/ARTIST DATE
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: Phone Number: PROCEDURE(S) DESIRED: Check all of the following that apply. Brows 3D Microblading (2 visits) Shaded/Powdered Brows (2 visits) 6D Microblading (2 visits) Re-touch (per session) Eye Liner Lash Liner (2 visits) Tear Line Liner (per session) Designer Liner (2 visits) Re-touch (per session) Removal of Permanent Makeup (per session) ALLERGIES: Check if you have ever had an allergic reaction to any of the following and described what happened below. Latex rubber Tattoo ink/pigment Novovaine, Lidocaine Benzocaine, Tetracaine Lanolin Bacitracin Ointment Neomycin or polymyxin B ointment PABA Metal(s) Foods: Other allergies: Reaction: EYES/EYEBROWS: Check all of the following that apply. Contact lenses Dry eyes Eye makeup sensitivities Blurred Vision Glaucoma Lasik /eye surgery Thyroid abnormalities Alopecia Areata (local) Alopecia Universalis (total) Pull out lashes/eyebrow compulsively (Trichotillomania) Other hair loss (describe): Eyebrow/Lash tinting Date of last service: Other eye disorders: Botox Date of last service:
SKIN: Check all of the following that apply. Any other tattoos - Location: Age of tattoo: Any problems: Use of sunlamp/tanning bed/suntan outdoors Currently tanned in the area being treated. Currently use Retin A - Location: Currently using glycolic acid, AHA or Retinol? Injectables such as Restylane, Juvederm or other fillers? Ever had a chemical peel? When: Type of peel: Do you have a scar you want camouflaged? Age of Scar: Any keloid or hypertrophic scars? - Location: Do you bruise or bleed easily? Do you have healing problems? Other active skin disorders? Describe: GENERAL MEDICAL: Check all of the following that apply. Diabetes Heart Palpitations High blood pressure Mitral valve prolapse or valve implants Pregnant or nursing Hemophilia or other clotting disorders Taken Accutane within the last 6 months Currently on blood thinners or anticoagulants such as Coumadin, aspirin, ibuprofin, alcohol? Autoimmune disorders - describe: Do you have a condition such as Hepatitis, HIV or undergoing treatment such as chemotherapy that could affect healing? Seizures - describe: Current use of controlled substances - describe: Please list any surgeries: If you are planning cosmetic or other surgeries/procedures in the near future, describe: List all medications, prescription and non-prescription that you have taken in the last two weeks: If you are currently under a physician s care for any condition, describe: Physician s Name: City: Phone: This history has been reviewed by the technician and my questions have been satisfactorily answered. I have also received and reviewed a copy of the Pre-Procedure Information Sheet and the After Care Sheet. I understand them and agree to follow them. Signature: Date:
CLIENT CHART NOTES Client: Technician: JUNG CECILIA LIM Consultation Date: Procedure: Date: Fees Paid: Needle: Color/Mfr: Lot num: Anesthetic: Photo Taken: Client initials - observed new needle was used Procedure: Date: Fees Paid: Needle: Color/Mfr: Lot num: Anesthetic: Photo Taken: Client initials - observed new needle was used Procedure: Date: Fees Paid: Needle: Color/Mfr: Lot num: Anesthetic: Photo Taken: Client initials - observed new needle was used Procedure Notes:
Approximate Healing Schedule for Permanent Cosmetics Eye Brows Day: What to Expect: 1-2 What you see is about 20-40% darker, bolder and more solid that what your healed result will present. Under the pigment, the skin is red and pigment has been deposited into the layer of skin containing dead skin cells; combined giving the appearance of darker color. There may be minimal swelling but because typically the eyebrow area does not retain much fluid, swelling will be limited. The top layers of skin will begin to shed on about day 3-5, and you will see a loss of color. This is normal, and the pigment that was deposited superficially will come off with the skin it is embedded within. DO NOT HELP IT! Let it peel on its own. To pull the skin off, you will remove 'plugs' of dermal pigments as it has not detached itself completely at this point. 3 Your eyebrows may begin to itch and the pigment may appear somewhat raised. Don't scratch them. 4-6 The skin is now in the throes of rapid exfoliation and if left alone, will shed evenly. The color under the exfoliating skin will continue to appear light until the epidermis takes on its more transparent characteristics. 14-45 Now is the time to critique your brows as you have had a full cycle of cellular regeneration in which the tattoo has now become part of the dermis, seen under the epidermis.
Approximate Healing Schedule for Permanent Cosmetics Eye Liner Day: What to Expect: 1 This can vary from slightly puffy to swollen, heavy lids, light sensitive and possibly bloodshot. They feel more swollen than they actually appear. Makeup looks quite heavily applied. It's advisable to sleep in an elevated position to help reduce swelling at night. Also, do not use your best pillowcase the first two nights. 2 Eyes will be swollen and perhaps a bit 'crusty' upon waking. The swelling will disappear from being in an upright position and from blinking, etc., increasing circulation to the area. Avoid heavy lifting, physical exertion and crying. 3 Eyes will be less swollen, but still tight. The lash area will feel sore if touched. 4 Pigment within the epidermis will begin to flake off in little stitch looking lines, although some people do not notice the exfoliation at all. DO NOT PICK- you will pull DERMAL pigment and end up with uneven color. 5 Blinking helps to eliminate the small pieces of pigment and epidermis which has detached. It is important not to pick at it or rub the eyes. 7 All shedding should be complete. You're safe to put your face back in the shower spray.
PERMANENT COSMETICS AFTER CARE INSTRUCTIONS Proper care following your procedure is necessary to achieve the best results. Keep in mind that in many cases, some unevenness of color is to be expected. This is the purpose of the touch-up visit. Please review the following directions and refer to them as necessary. If during your healing process you have any questions or concerns, please contact your technician. 1. Ice packs protected with a cloth may be applied as necessary to reduce swelling. Sleeping slightly elevated helps alleviate swelling sometimes seen the morning after facial procedures. 2. Wash your hands before touching any treated area. Cotton-tipped applicators may be used to gently cleanse the eye area. Do not expose the area to dirty or unsanitary conditions. Wearing glasses outdoors is a good way to protect new eyeliner from dust, etc., that can stick to healing agents. Apply recommended healing agents sparingly. 3. Some itching is normal. DO NOT PICK, PEEL, OR SCRATCH the treated area or your color may heal unevenly and you risk scarring and infection. 4. No makeup is to be applied for 72 hours after the procedure. After any eyeliner procedure, use new mascara. Do not use an eyelash curler for two weeks. 5. Do not expose your healing skin to direct sun, tanning beds, hot tubs, (tub baths if body area treated), saunas, salt water, chlorinated pools, direct shower spray, hot water, skin creams, ointments, or lotions other than what you have been instructed to use for 2 weeks following your procedure. LONG-TERM CARE 1. Use a good sunscreen daily. Sun exposure will fade your permanent cosmetics and may cause irritation even years later. 2. If you are planning chemical exfoliation, MRI, or other medical procedure, please inform your physician of your cosmetic tattoo. 3. If you donate blood, it is a Red Cross policy that you must wait one year after any tattooing procedure in unregulated states check if restrictions apply to you.