Common use of Allergic Reaction Clause in Contracts

Allergic Reaction. There is a small possibility of an allergic reaction. You may take a 5-7 day patch test to deter- mine this. Please initial to: Waive or Take . The alternative to these possibilities is to use cosmetics and not undergo the 3D Microblading - Brows by El Paso Microblading, semi-permanent technique. Consent and release for procedures performed: Signed: Date: Statement of Consent and Recitals Please read and initial all lines Aftercare instructions have been explained to me and a written copy has been given to me to retain in my possession, which I will follow to the best of my ability. If I have questions, I will call or email you. I understand that a certain amount of discomfort is associated with this procedure, and that swelling, redness and bruising may occur. I understand that Retin A, Renova, Alpha Hydroxy and Glycolic Acids must not be used on treated areas. They will alter the color and cause premature exfoliation of the pigment. I understand that tanning beds, pools, some skin care products and medications can affect my permanent makeup. I understand that successful color saturation can NOT be guaranteed due to hidden scar tissue. I will tell all skin care professionals or medical personnel about my permanent makeup procedures, especially if I am scheduled for an MRI. I accept the responsibility to explain to you by desire for specific colors, shape, and position for any procedure done today. I understand that implanted pigment color can slightly change or fade over time due to circumstances beyond your control, and I will need to maintain the color with future applications and a touch-up session within 60 days. I acknowledge that the proposed procedures(s) involve risks inherent in the procedure, and have possibilities of complications during and/or following the procedures such as: infection, misplaced pigment, poor color retention and hyper-pigmentation. I have been advised that a touch-up session is highly recommended to make any adjustments to shape, color, and to fill any pigment that may have had poor retention. Touch-ups must be completed within 60 days of initial procedure. I have been quoted the cost of today’s appointment, and the cost of the touch-up. Touch-ups must be completed within 60 days of initial procedure to be considered a touch-up price. I certify that I have read or have had read to me the contents of this form. I understand the risks and alternatives involved in this procedure(s). I have had the opportunity to ask questions, and all of my questions have been answered. I acknowledge that I have reviewed and approved the material given to me, and I authorize the technician, to perform on my body Semi-Permanent Cosmetics 3D Microblading – El Paso Microblading on the scheduled dated as discussed. Signed: Date: Aftercare After care is very important for producing a beautiful and lasting result. • Keep the area clean by washing with freshly washed hands and a mild soap. Do not use a washcloth or sponge to remove soap. Simply splash with water. Do not use cleansing creams, acne cleansers or astringents. Use a mild, natural soap. • Apply the aftercare balm with freshly washed hands or a Q-tip. If the balm is too stiff to use simply warm it up in a glass of warm water or on your finger. Use the balm very sparingly. Too little is better than too much. Blot off excess with a clean tissue. Never touch the procedure area without washing your hands immediately before. • Do not scrub, rub or pick at the epithelial crust that forms. Allow it to flake off by itself. If it is removed before it is ready the pigment underneath it can be pulled out. • Do not use any makeup near the procedure area including mascara for eyeliner procedures for at least 3 days. Purchase new mascara and makeup if possible to avoid contamination or bacterial infection. • Always use a sun block after the procedure area is healed to protect from sun fading. What’s normal? • Mild swelling, itching, light scabbing, light bruising and dry tightness. Ice packs are a nice relief for swelling and bruising. Aftercare balm is nice for scabbing and tightness. • Too dark and slightly uneven appearance. After 2-7 days the darkness will fade and once swelling dissipates unevenness usually disappears. If they are too dark or still a bit uneven after 4 weeks then we will make adjustments during the touch up appointment. • Color change or color loss. As the procedure area heals the color will lighten and sometimes seem to disappear. This can all be addressed during the touch up appointment and is why the touch up is necessary. The procedure area has to be completely healed before we can address any concerns. This takes about four weeks. • Needing a touch up months or years later. A touch up may be needed 6 months to 2 years after the touch up procedure depending on your skin, medications and sun exposure. We recommend the touch up 30 days after the first session (included in today’s price) and every 6 months to 2 years to keep them looking fresh and beautiful. Touch up sessions after 60 days will be $150 or current touch up rate at time of touch up. **Failure to follow after care instructions may result in infections, pigment loss or discoloration. I have read, understand and agree to the above instructions. Signed: Date: Client Medical History Form Date: Birthdate: Name: Address: City: State: Zip: Phone#: Email: Emergency Person Phone: Phone#: Do you have or previously had any of the following: (Cirlce YES or No) YES NO History of MRSA YES NO Botox (Last treatment ) YES NO Diabetes YES NO Hepatitis A B C D YES NO Forehead/Brow Lift YES NO Easy Bleeding YES NO Facelift YES NO Alcoholism YES NO Abnormal Heart Condition YES NO Take medication before dental work YES NO Chemical Peel (Last Treatment ) YES NO Pregnant now – Breastfeeding now YES NO Brow Lash Tinting YES NO Autoimmune disorder YES NO Oily Skin YES NO Cancer (Year ) YES NO Accutane or acne treatment YES NO Chemotherapy/ Radiation YES NO Tan by booth or salon YES NO Tumors/ Growth/ Cysts YES NO Difficulty numbing with dental work YES NO Taking blood thinners such as: Aspirin, Ibuprofen, Alcohol, Coumadin etc YES NO Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylene Glycol, Vitamin E Acetate, etc YES NO Allergies to metals, food, etc YES NO Any diseases or disorders not listed YES NO Do you use skin care products containing Retin-A, Glycolic Acid, or Alpha Hydroxyl? Please list any medications you are taking I agree that all the above information is true and accurate to the best of my knowledge. Signed: Date:

Allergic Reaction. There is a small possibility of an allergic reaction. You may take a 5-7 day patch test to deter- mine this. Please initial to: Waive or Take . The alternative to these possibilities is to use cosmetics and not undergo the 3D Microblading - Brows by El Paso Microblading, semi-permanent technique. Consent and release for procedures performed: Signed: Date: Statement of Consent and Recitals Please read and initial all lines Aftercare instructions have been explained to me and a written copy has been given to me to retain in my possession, which I will follow to the best of my ability. If I have questions, I will call or email you. I understand that a certain amount of discomfort is associated with this procedure, and that swelling, redness and bruising may occur. I understand that Retin A, Renova, Alpha Hydroxy and Glycolic Acids must not be used on treated areas. They will alter the color and cause premature exfoliation of the pigment. I understand that tanning beds, pools, some skin care products and medications can affect my permanent makeup. I understand that successful color saturation can NOT be guaranteed due to hidden scar tissue. I will tell all skin care professionals or medical personnel about my permanent makeup procedures, especially if I am scheduled for an MRI. I accept the responsibility to explain to you by desire for specific colors, shape, and position for any procedure done today. I understand that implanted pigment color can slightly change or fade over time due to circumstances beyond your control, and I will need to maintain the color with future applications and a touch-up session within 60 days. I acknowledge that the proposed procedures(s) involve risks inherent in the procedure, and have possibilities of complications during and/or following the procedures such as: infection, misplaced pigment, poor color retention and hyper-pigmentation. I have been advised that a touch-up session is highly recommended to make any adjustments to shape, color, and to fill any pigment that may have had poor retention. Touch-ups must be completed within 60 days of initial procedure. I have been quoted the cost of today’s appointment, and the cost of the touch-up. Touch-ups must be completed within 60 days of initial procedure to be considered a touch-up price. I certify that I have read or have had read to me the contents of this form. I understand the risks and alternatives involved in this procedure(s). I have had the opportunity to ask questions, and all of my questions have been answered. I acknowledge that I have reviewed and approved the material given to me, and I authorize the technician, to perform on my body Semi-Permanent Cosmetics 3D Microblading – El Paso Microblading on the scheduled dated as discussed. Signed: Date: Aftercare After care is very important for producing a beautiful and lasting result. • Keep the area clean by washing with freshly washed hands and a mild soap. Do not use a washcloth or sponge to remove soap. Simply splash with water. Do not use cleansing creams, acne cleansers or astringents. Use a mild, natural soap. • Apply the aftercare balm with freshly washed hands or a Q-tip. If the balm is too stiff to use simply warm it up in a glass of warm water or on your finger. Use the balm very sparingly. Too little is better than too much. Blot off excess with a clean tissue. Never touch the procedure area without washing your hands immediately before. • Do not scrub, rub or pick at the epithelial crust that forms. Allow it to flake off by itself. If it is removed before it is ready the pigment underneath it can be pulled out. • Do not use any makeup near the procedure area including mascara for eyeliner procedures for at least 3 days. Purchase new mascara and makeup if possible to avoid contamination or bacterial infection. • Always use a sun block after the procedure area is healed to protect from sun fading. What’s normal? • Mild swelling, itching, light scabbing, light bruising and dry tightness. Ice packs are a nice relief for swelling and bruising. Aftercare balm is nice for scabbing and tightness. • Too dark and slightly uneven appearance. After 2-7 days the darkness will fade and once swelling dissipates unevenness usually disappears. If they are too dark or still a bit uneven after 4 weeks then we will make adjustments during the touch up appointment. • Color change or color loss. As the procedure area heals the color will lighten and sometimes seem to disappear. This can all be addressed during the touch up appointment and is why the touch up is necessary. The procedure area has to be completely healed before we can address any concerns. This takes about four weeks. • Needing a touch up months or years later. A touch up may be needed 6 months to 2 years after the touch up procedure depending on your skin, medications and sun exposure. We recommend the touch up 30 days after the first session (included in today’s price) and every 6 months to 2 years to keep them looking fresh and beautiful. Touch up sessions after 60 days will be $150 or current touch up rate at time of touch up. **Failure to follow after care instructions may result in infections, pigment loss or discoloration. I have read, understand and agree to the above instructions. Signed: Date: Client Medical History Form Date: Birthdate: Name: Address: City: State: Zip: Phone#: Email: Emergency Person Phone: Phone#: Do you have or previously had any of the following: (Cirlce YES or No) YES NO History of MRSA YES NO Botox (Last treatment ) YES NO Diabetes YES NO Hepatitis A B C D YES NO Forehead/Brow Lift YES NO Easy Bleeding YES NO Facelift YES NO Alcoholism YES NO Abnormal Heart Condition YES NO Take medication before dental work YES NO Chemical Peel (Last Treatment ) YES NO Pregnant now – Breastfeeding now YES NO Brow Lash Tinting YES NO Autoimmune disorder YES NO Oily Skin YES NO Cancer (Year ) YES NO Accutane or acne treatment YES NO Chemotherapy/ Radiation YES NO Tan by booth or salon YES NO Tumors/ Growth/ Cysts YES NO Difficulty numbing with dental work YES NO Taking blood thinners such as: Aspirin, Ibuprofen, Alcohol, Coumadin etc YES NO Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylene Glycol, Vitamin E Acetate, etc YES NO Allergies to metals, food, etc YES NO Any diseases or disorders not listed YES NO Do you use skin care products containing Retin-A, Glycolic Acid, or Alpha Hydroxyl? Please list any medications you are taking I agree that all the above information is true and accurate to the best of my knowledge. Signed: Date:.

Allergic Reaction. There is a small possibility of an allergic reaction. You may take a 5-7 day days patch test to deter- mine determine this. Please initial to: Waive Waive_________ or Take _. The alternative to these possibilities is to use cosmetics and not undergo the 3D Microblading - Brows by El Paso Microblading, semi-permanent techniquePermanent Cosmetics procedure. Consent and release for procedures performed: Signed: Date: Statement of Consent and Recitals Signature _______________________________________ Date ________________________ Gloss Nail Spa STATEMENT OF CONSENT AND RECITALS Please read and initial all lines _____ Aftercare instructions have been explained to me and a written copy has been will be given to me to retain in my possession, which I will follow to the best of my ability. If I have questions, questions I will call or email you. I understand that a certain amount of discomfort is associated with this procedure, procedure and that swelling, redness and bruising may occur. I understand that Retin Asun, Renova, Alpha Hydroxy and Glycolic Acids must not be used on treated areas. They will alter the color and cause premature exfoliation of the pigment. I understand that tanning beds, pools, some skin care products and medications can affect my permanent makeup. I understand that successful color saturation can NOT be guaranteed due to hidden scar tissue. I will tell all skin care professionals or medical personnel about my permanent makeup procedures, especially if I am scheduled I’m schedule for an MRI. I accept the responsibility to for explain to you by my desire for specific colors, colors shape, and position for any procedure done today. I understand that implanted pigment color can slightly change or fade over time due to circumstances beyond your control, control and I will need to maintain the color with future applications and a touch-touch up session within 60 days. I acknowledge that the proposed procedures(sprocedure(s) involve involved risks inherent in the procedure, procedure and have possibilities of complications during and/or following the procedures such as: infectioninfections, misplaced pigment, poor color retention and hyper-pigmentation. I have been advised that a touch-up session is highly recommended to make any adjustments to shape, color, and to fill any pigment that may have had poor retention. Touch-ups must be completed within 60 days of initial procedurehyperpigmentation. I have been quoted the cost of today’s appointment, which includes one (1), touch up after 30 days and the cost of the touch-up. Touch-ups must be completed within 60 days. After 60 days of initial procedure a fee will apply and there will be no refunds for this elective procedure(s). I accept full responsibility for the decision to be considered a touch-up pricehave this cosmetic tattoo work done. I certify that I have read or have had read to me the contents of this form. I understand the risks and alternatives involved in this procedure(s). ) and I have had the opportunity to ask questions, questions and all of my questions have been answered. I acknowledge that I have reviewed and approved the material given to me, me and I authorize the technician, as my permanent cosmetics technician to perform on my body Semi-Permanent Cosmetics 3D Microblading – El Paso Microblading on the scheduled dated as discussedfollowing procedures. Signed: Date: Aftercare Signature _______________________________________________ Date ____________________________ Gloss Nail Spa AFTERCARE After care is very important for producing a beautiful and lasting result. •  Keep the area clean by washing with freshly washed hands and a mild soap. Do not use a washcloth or sponge to remove soap. Simply splash with water. Do not use cleansing creams, acne cleansers or astringents. Use a mild, natural soap. •  Apply the aftercare balm with freshly washed hands or a Q-tip. If the balm is too stiff to use simply warm it up in a glass of warm water or on your finger. Use the balm very sparingly. Too little is better than too much. Blot off excess with a clean tissue. Never touch the procedure area without washing your hands immediately before. •  Do not scrub, rub or pick at the epithelial crust that forms. Allow it to flake off by itself. If it is removed before it is ready the pigment underneath it can be pulled out. •  Do not use any makeup near the procedure area including mascara for eyeliner procedures for at least 3 days. Purchase new mascara and makeup if possible to avoid contamination or bacterial infection. •  Always use a sun block after the procedure area is healed to protect from sun fading. What’s normalNormal? • Mild swelling Swelling, itching, light scabbing, light bruising and dry tightness. Ice packs are a nice relief for swelling and bruising. Aftercare balm calm is nice for scabbing and tightness. •  Too dark and slightly uneven appearance. After 2-7 days the darkness will fade and once swelling dissipates unevenness usually disappears. If they are too dark or still a bit uneven after 4 weeks then we will make adjustments during the touch up appointment. •  Color change or color loss. As the procedure area heals the color will lighten and sometimes seem to disappear. This can all be addressed during the touch up appointment and is why the touch up is necessary. The procedure area has to be completely healed before we can address any concerns. This takes about at least four weeks. •  Needing a touch up months or years later. A touch up may be needed 6 months 1 to 2 5 years after the touch up initial procedure depending on your skin, medications and sun exposure. We recommend the a touch up 30 days after the first session (included in today’s price) and every 6 months to 2 few years to keep them looking fresh and beautiful. Touch up sessions after 60 days will be $150 195 or current touch up rate at time of touch up. **Failure to follow after care instructions may result in infections, pigment loss or discoloration. I have read, understand and agree to the above instructions. Signed: Date: Signature ________________________________ Date _______________________ Gloss Nail Spa Client Medical History Form DateDate _____________________ First name: ________________________ Last name: _______________________ Birthdate: Name: _________________________ Address: :_________________________________________________________________ City: ___________________________ State: _____________ Zip: Phone#________________ Phone number: _____________________ Email: __________________________ Emergency Person contact: Person: _______________________________ Phone: Phone#: _________________________ Do you presently have or previously had any of the following: (Cirlce Circle YES or NoNO) YES NO History of MRSA YES NO Botox (Last treatment ) YES NO Diabetes YES NO Hepatitis A B C D Lip Fillers/Restylane/Juve derm YES NO ForeheadCold Sores/Fever Blisters ever? YES NO Blepharoplasty (Eyelid surgery) YES NO Hepatitis (A, B, C, D) YES NO Brow Lift lift YES NO Easy Bleeding bleeding YES NO Facelift Face lift YES NO Alcoholism YES NO Eye surgery/injury/Corneal abrasion YES NO Abnormal Heart Condition YES NO Take medication before dental work Contact Lenses now YES NO Chemical Peel (Last Treatment last treatment ) YES NO Pregnant now – Breastfeeding now/Breast feeding now YES NO Brow or Lash Tinting YES NO Autoimmune disorder tinting YES NO Oily Skin YES NO Cancer (Year ) YES NO Accutane or acne treatment YES NO Chemotherapy/ Radiation YES NO Tan by booth or salon YES NO Tumors/ Growth/ Cysts sun YES NO Difficulty numbing with dental work YES NO Taking blood thinners such as: Aspirin, Ibuprofen, Alcoholalcohol, Coumadin etc Coumadin, etc. YES NO Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylene Glycolalcohol, Vitamin E Acetate, etc etc. LIST YES NO Allergies to metalsmetal, food, etc etc. LIST YES NO Any diseases or disorders not listed listed? LIST YES NO Do you use skin care products containing Retin-A, Glycolic Acid, glycolic acid or Alpha Hydroxylalpha hydroxyl? Please list any medications or vitamins you are taking presently taking: I agree that all the above information is true and accurate to the best of my knowledge. SignedSignature __________________________________ Date ______________________ Gloss Nail Spa BEFORE AND AFTER YOUR TREATMENT Before your treatment Prior to your permanent cosmetic enhancement think about the look that you wish to achieve. As experts in the field of color analysis and makeovers, we ensure that the correct colors and styles are chosen for you, however you are part of the decision making process. Permanent cosmetic enhancements normally require multiple application sessions. To achieve the best results, you will be required to return for at least one control procedure four to six weeks after the initial application. Be prepared for the color intensity to be significantly sharper and darker immediately after the procedure. This will subside and become softer as the skin heals. This process can take up to fourteen days. -Since delicate skin or sensitive areas may be swollen or red, you are advised not to make social plans on the day of your enhancement. -Please wear your normal make-up to your enhancement appointment. -Do not take aspirin or Ibuprofen 2 days prior to and after your enhancement. -A sensitivity test will be performed unless waived upon request. -Do not use Retin-A skincare products close to the enhancement area 2 weeks prior to and after your procedure. -As with electrolysis the National Blood Service does not accept donations of blood for 1 year after a permanent cosmetic enhancement. Eyebrow Enhancement -Waxing treatments should be performed no less than 3 days prior to your enhancement. -IPL laser hair removal should be performed no less than 2 weeks prior to your enhancement. -Electrolysis treatments should be performed no less than 5 days prior to your enhancement. -Eyebrow tinting should not be undertaken for 2 weeks after your enhancement. After your treatment The area treated may show redness and swelling and that the color looks dark and intense—this is quite normal. Additional treatments cannot be undertaken until the area has completely healed. A 4/6 weeks healing time is required before any more work can be undertaken. In order to let your brows heal well, avoid water on the brow area; make up to the brow area, the gym, sauna or pool for 7 days. Once the area has healed completely, approximately one week, consider using a waterproof total sunblock when going out in the sun to stop the color fading. Strong chemicals or glycolic acid/peels of any kind may cause the pigment to lighten. Always telephone and check with your consultant if in any doubt. Do not pick or pull at the treated area, as it will result in pigment loss. You will go through three healing phases: Date:1-healing, 2-peeling, and 3- fadeing. You may notice whiteness or blanching around the area, this is quite normal and will subside within 12 hours. If you find any lymphatic fluid or blood weeping you can gently clean the area with saline, cool boiled water and gauze, blotting gently dry to remove any moisture. With clean hands and cotton pad apply a fine layer of aftercare balm to the treated area. Repeat this procedure up to 3 times a day if the area feels tight. After the fine scabbing has sloughed away you will see a different hue to the color implanted.

Allergic Reaction. There is a small possibility of an allergic reaction. You may take a 5-7 day days patch test to deter- mine determine this. Please initial to: Waive Waive_________ or Take _. The alternative to these possibilities is to use cosmetics and not undergo the 3D Microblading - Brows by El Paso Microblading, semi-permanent techniquePermanent Cosmetics procedure. Consent and release for procedures performed: Signed: Date: Statement of Consent and Recitals Signature _______________________________________ Date ________________________ Gloss Nail Spa STATEMENT OF CONSENT AND RECITALS Please read and initial all lines _____ Aftercare instructions have been explained to me and a written copy has been will be given to me to retain in my possession, which I will follow to the best of my ability. If I have questions, questions I will call or email you. I understand that a certain amount of discomfort is associated with this procedure, procedure and that swelling, redness and bruising may occur. I understand that Retin Asun, Renova, Alpha Hydroxy and Glycolic Acids must not be used on treated areas. They will alter the color and cause premature exfoliation of the pigment. I understand that tanning beds, pools, some skin care products and medications can affect my permanent makeup. I understand that successful color saturation can NOT be guaranteed due to hidden scar tissue. I will tell all skin care professionals or medical personnel about my permanent makeup procedures, especially if I am scheduled I’m schedule for an MRI. I accept the responsibility to for explain to you by my desire for specific colors, colors shape, and position for any procedure done today. I understand that implanted pigment color can slightly change or fade over time due to circumstances beyond your control, control and I will need to maintain the color with future applications and a touch-touch up session within 60 days. I acknowledge that the proposed procedures(sprocedure(s) involve involved risks inherent in the procedure, procedure and have possibilities of complications during and/or following the procedures such as: infectioninfections, misplaced pigment, poor color retention and hyper-pigmentation. I have been advised that a touch-up session is highly recommended to make any adjustments to shape, color, and to fill any pigment that may have had poor retention. Touch-ups must be completed within 60 days of initial procedurehyperpigmentation. I have been quoted the cost of today’s appointment, which includes one (1), touch up after 30 days and the cost of the touch-up. Touch-ups must be completed within 60 days. After 60 days of initial procedure a fee will apply and there will be no refunds for this elective procedure(s). I accept full responsibility for the decision to be considered a touch-up pricehave this cosmetic tattoo work done. I certify that I have read or have had read to me the contents of this form. I understand the risks and alternatives involved in this procedure(s). ) and I have had the opportunity to ask questions, questions and all of my questions have been answered. I acknowledge that I have reviewed and approved the material given to me, me and I authorize the technician, as my permanent cosmetics technician to perform on my body Semi-Permanent Cosmetics 3D Microblading – El Paso Microblading on the scheduled dated as discussedfollowing procedures. Signed: Date: Aftercare Signature _______________________________________________ Date ____________________________ Gloss Nail Spa AFTERCARE After care is very important for producing a beautiful and lasting result. • Keep the area clean by washing with freshly washed hands and a mild soap. Do not use a washcloth or sponge to remove soap. Simply splash with water. Do not use cleansing creams, acne cleansers or astringents. Use a mild, natural soap. • Apply the aftercare balm with freshly washed hands or a Q-tip. If the balm is too stiff to use simply warm it up in a glass of warm water or on your finger. Use the balm very sparingly. Too little is better than too much. Blot off excess with a clean tissue. Never touch the procedure area without washing your hands immediately before. • Do not scrub, rub or pick at the epithelial crust that forms. Allow it to flake off by itself. If it is removed before it is ready the pigment underneath it can be pulled out. • Do not use any makeup near the procedure area including mascara for eyeliner procedures for at least 3 days. Purchase new mascara and makeup if possible to avoid contamination or bacterial infection. • Always use a sun block after the procedure area is healed to protect from sun fading. What’s normalNormal? • Mild swellingSwelling, itching, light scabbing, light bruising and dry tightness. Ice packs are a nice relief for swelling and bruising. Aftercare balm calm is nice for scabbing and tightness. • Too dark and slightly uneven appearance. After 2-7 days the darkness will fade and once swelling dissipates unevenness usually disappears. If they are too dark or still a bit uneven after 4 weeks then we will make adjustments during the touch up appointment. • Color change or color loss. As the procedure area heals the color will lighten and sometimes seem to disappear. This can all be addressed during the touch up appointment and is why the touch up is necessary. The procedure area has to be completely healed before we can address any concerns. This takes about at least four weeks. • Needing a touch up months or years later. A touch up may be needed 6 months 1 to 2 5 years after the touch up initial procedure depending on your skin, medications and sun exposure. We recommend the a touch up 30 days after the first session (included in today’s price) and every 6 months to 2 few years to keep them looking fresh and beautiful. Touch up sessions after 60 days will be $150 195 or current touch up rate at time of touch up. **Failure to follow after care instructions may result in infections, pigment loss or discoloration. I have read, understand and agree to the above instructions. Signed: Date: Signature ________________________________ Date _______________________ Gloss Nail Spa Client Medical History Form DateDate _____________________ First name: ________________________ Last name: _______________________ Birthdate: Name: _________________________ Address: :_________________________________________________________________ City: ___________________________ State: _____________ Zip: Phone#________________ Phone number: _____________________ Email: __________________________ Emergency Person contact: Person: _______________________________ Phone: Phone#: _________________________ Do you presently have or previously had any of the following: (Cirlce Circle YES or NoNO) YES NO History of MRSA YES NO Botox (Last treatment ) YES NO Diabetes YES NO Hepatitis A B C D Lip Fillers/Restylane/Juve derm YES NO ForeheadCold Sores/Fever Blisters ever? YES NO Blepharoplasty (Eyelid surgery) YES NO Hepatitis (A, B, C, D) YES NO Brow Lift lift YES NO Easy Bleeding bleeding YES NO Facelift Face lift YES NO Alcoholism YES NO Eye surgery/injury/Corneal abrasion YES NO Abnormal Heart Condition YES NO Take medication before dental work Contact Lenses now YES NO Chemical Peel (Last Treatment last treatment ) YES NO Pregnant now – Breastfeeding now/Breast feeding now YES NO Brow or Lash Tinting YES NO Autoimmune disorder tinting YES NO Oily Skin YES NO Cancer (Year ) YES NO Accutane or acne treatment YES NO Chemotherapy/ Radiation YES NO Tan by booth or salon YES NO Tumors/ Growth/ Cysts sun YES NO Difficulty numbing with dental work YES NO Taking blood thinners such as: Aspirin, Ibuprofen, Alcoholalcohol, Coumadin etc Coumadin, etc. YES NO Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylene Glycolalcohol, Vitamin E Acetate, etc etc. LIST YES NO Allergies to metalsmetal, food, etc etc. LIST YES NO Any diseases or disorders not listed listed? LIST YES NO Do you use skin care products containing Retin-A, Glycolic Acid, glycolic acid or Alpha Hydroxylalpha hydroxyl? Please list any medications or vitamins you are taking presently taking: I agree that all the above information is true and accurate to the best of my knowledge. SignedSignature __________________________________ Date ______________________ Gloss Nail Spa BEFORE AND AFTER YOUR TREATMENT Before your treatment Prior to your permanent cosmetic enhancement think about the look that you wish to achieve. As experts in the field of color analysis and makeovers, we ensure that the correct colors and styles are chosen for you, however you are part of the decision making process. Permanent cosmetic enhancements normally require multiple application sessions. To achieve the best results, you will be required to return for at least one control procedure four to six weeks after the initial application. Be prepared for the color intensity to be significantly sharper and darker immediately after the procedure. This will subside and become softer as the skin heals. This process can take up to fourteen days. -Since delicate skin or sensitive areas may be swollen or red, you are advised not to make social plans on the day of your enhancement. -Please wear your normal make-up to your enhancement appointment. -Do not take aspirin or Ibuprofen 2 days prior to and after your enhancement. -A sensitivity test will be performed unless waived upon request. -Do not use Retin-A skincare products close to the enhancement area 2 weeks prior to and after your procedure. -As with electrolysis the National Blood Service does not accept donations of blood for 1 year after a permanent cosmetic enhancement. Eyebrow Enhancement -Waxing treatments should be performed no less than 3 days prior to your enhancement. -IPL laser hair removal should be performed no less than 2 weeks prior to your enhancement. -Electrolysis treatments should be performed no less than 5 days prior to your enhancement. -Eyebrow tinting should not be undertaken for 2 weeks after your enhancement. After your treatment The area treated may show redness and swelling and that the color looks dark and intense—this is quite normal. Additional treatments cannot be undertaken until the area has completely healed. A 4/6 weeks healing time is required before any more work can be undertaken. In order to let your brows heal well, avoid water on the brow area; make up to the brow area, the gym, sauna or pool for 7 days. Once the area has healed completely, approximately one week, consider using a waterproof total sunblock when going out in the sun to stop the color fading. Strong chemicals or glycolic acid/peels of any kind may cause the pigment to lighten. Always telephone and check with your consultant if in any doubt. Do not pick or pull at the treated area, as it will result in pigment loss. You will go through three healing phases: Date:1-healing, 2-peeling, and 3- fadeing. You may notice whiteness or blanching around the area, this is quite normal and will subside within 12 hours. If you find any lymphatic fluid or blood weeping you can gently clean the area with saline, cool boiled water and gauze, blotting gently dry to remove any moisture. With clean hands and cotton pad apply a fine layer of aftercare balm to the treated area. Repeat this procedure up to 3 times a day if the area feels tight. After the fine scabbing has sloughed away you will see a different hue to the color implanted.

Allergic Reaction. There is a small possibility of an allergic reaction. You may take a 5-7 day patch test to deter- mine determine this. Please initial to: Waive or Take . The alternative to these possibilities is to use cosmetics and not undergo the 3D Microblading - Brows by El Paso Microblading, semi-permanent techniquePermanent Cosmetics procedure. Consent and release for procedures performed: SignedSigned Date_ STATEMENT OF CONSENT AND RECITALS: Date: Statement of Consent and Recitals Please read and initial all lines Aftercare instructions have been explained to me and a written copy has been will be given to me to retain in my possession, which I will follow to the best of my ability. If I have questions, questions I will call or email you. I understand that a certain amount of discomfort is associated with this procedure, procedure and that swelling, redness and bruising may occur. Fever blisters may occur in lip procedures in individuals who have the herpes simplex virus and it is my responsibility to obtain a prescription from my doctor for an anti-viral medication to help avoid a breakout. I understand that Retin A, Renova, Alpha Hydroxy and Glycolic Acids must not be used on the treated areas. They will alter the color and cause premature exfoliation of the pigmentcolor. I understand that sun, tanning beds, pools, some skin care products and medications can affect my permanent makeup. I understand that successful lip color saturation can NOT be guaranteed due to hidden scar tissue. I will tell all skin care professionals or medical personnel about my permanent makeup procedures, especially if I am scheduled I’m schedule for an MRI. I accept the responsibility to for explain to you by my desire for specific colors, shape, and position for any procedure done today. I understand that implanted pigment color can slightly change or fade over time due to circumstances beyond your control, control and I will need to maintain the color with future applications and a touch-touch up session within 60 days. I acknowledge that the proposed procedures(sprocedure(s) involve risks inherent in the procedure, procedure and have possibilities of complications during and/or following the procedures such as: infection, misplaced pigment, poor color retention and hyper-pigmentation. I have been advised that a touch-up session is highly recommended to make any adjustments to shape, color, and to fill any pigment that may have had poor retention. Touch-ups must be completed within 60 days of initial procedure. I have been quoted the cost of today’s appointment, appointment which includes one (1) touch up after 30 days and the cost of the touch-up. Touch-ups must be completed within 60 days. After 60 days of initial procedure to a fee will apply and there will be considered a touch-up priceno refunds for this elective procedure(s). I certify that I have read or have had read to me the contents of this form. I understand the risks and alternatives involved in this procedure(s). ) and I have had the opportunity to ask questions, questions and all of my questions have been answered. I acknowledge that I have reviewed and approved the material given to me, me and I authorize the technicianXxxxxxx, as my permanent cosmetics technician to perform on my body Semi-Permanent Cosmetics 3D Microblading – El Paso Microblading on the scheduled dated as discussedfollowing procedures. Signed: Date: (Procedure(s) desired to day) . Signature Date . Aftercare After care is very important for producing a beautiful and lasting result. • Keep the area clean by washing with freshly washed hands and a mild soap. Do not use a washcloth or sponge to remove soap. Simply splash with water. Do not use cleansing creams, acne cleansers or astringents. Use a mild, natural soap. • Apply the aftercare balm with freshly washed hands or a Q-tip. If the balm is too stiff to use simply warm it up in a glass of warm water or on your finger. Use the balm very sparingly. Too little is better than too much. Blot off excess with a clean tissue. Never touch the procedure area without washing your hands immediately before. • Do not scrub, rub or pick at the epithelial crust that forms. Allow it to flake off by itself. If it is removed before it is ready the pigment underneath it can be pulled out. • Do not use any makeup near the procedure area including mascara for eyeliner procedures for at least 3 days. Purchase new mascara and makeup if possible to avoid contamination or bacterial infection. • Always use a sun block after the procedure area is healed to protect from sun fading. What’s normal? • Mild swellingSwelling, itching, light scabbing, light bruising and dry tightness. Ice packs are a nice relief for swelling and bruising. Aftercare balm calm is nice for scabbing and tightness. • Too dark and slightly uneven appearance. After 2-7 days the darkness will fade and once swelling dissipates unevenness usually disappears. If they are too dark or still a bit uneven after 4 weeks then we will make adjustments during the touch up appointment. • Color change or color loss. As the procedure area heals the color will lighten and sometimes seem to disappear. This can all be addressed during the touch up appointment and is why the touch up is necessary. The procedure area has to be completely healed before we can address any concerns. This takes about at least four weeks. • Needing a touch up months or years later. A touch up may be needed 6 months 1 to 2 5 years after the touch up initial procedure depending on your skin, medications and sun exposure. We recommend the a touch up 30 days after the first session (included in today’s price) and every 6 months to 2 few years to keep them looking fresh and beautiful. Touch up sessions after 60 days will be $150 175 or current touch up rate at time of touch up. **Failure to follow after care instructions may result in infections, pigment loss or discoloration. I have read, understand and agree to the above instructions. Signed: Date: Signature- Date . Client Medical History Form Date: Birthdate: Date Birth Date _ _ Name: _ Address: City: State: Zip: _City State _Zip _ Phone # _Email _ _ Emergency contact person _Phone#: Email: Emergency Person Phone: Phone#: # _ Do you presently have or previously had any of the following: (Cirlce YES Circle yes or Nono) YES NO Yes No History of MRSA YES NO Yes No Botox Yes No Diabetes Yes No Lip fillers/ Restylane/ Juve derm Yes No Cold Sores/ Fever Blisters ever? Yes No Blepharoplasty (Last treatment Eyelid surgery) YES NO Diabetes YES NO Yes No Hepatitis A B C D YES NO (A,B,C,D) Yes No Forehead/Brow Lift YES NO lift Yes No Easy Bleeding YES NO Facelift YES NO bleeding Yes No Face lift Yes No Alcoholism YES NO Yes No Eye surgery/ injury/ Corneal abrasion Yes No Abnormal Heart Condition YES NO Yes No Contact Lenses now Yes No Take medication meds before dental Dental work YES NO Yes No Chemical Peel (Last Treatment last treatment ) YES NO Yes No Pregnant now/ Breast feeding now – Breastfeeding now YES NO Yes No Brow or Lash Tinting YES NO tinting Yes No Autoimmune disorder YES NO Disorder Yes No Oily Skin YES NO Yes No Cancer (Year ) YES NO year Yes No Accutane or acne treatment YES NO Yes No Chemotherapy/ Radiation YES NO Yes No Tan by booth or salon YES NO sun Yes No Tumors/ Growth/ Growths/ Cysts YES NO Yes No Difficulty numbing with dental work YES NO Yes No Taking blood thinners thinkers such as: Aspirin, Ibuprofen, Alcoholalcohol, Coumadin etc YES NO Coumadin, ect. Yes No Allergic reaction to any medications such as Lidocaine, Tetracaine, Epinephrine, Dermacaine, Benzyl Alcoholalcohol, Carbopol, Lecithin, Propylene Glycolglycol, Vitamin E Acetate, etc YES NO ect. List _ Yes No Allergies to metals, food, etc YES NO ect. _ _ Yes No Any diseases or disorders not listed YES NO listed: _ Yes No Do you use skin care products containing Retin-A, Glycolic Acid, glycolic acid or Alpha Hydroxylalpha hydroxyl? Please list any medications you are taking medication or vitamins you’re presently taking: _ _ I agree that all the above information is true and accurate to the best of my knowledge. Signed: Date:.