Microblading Waiver

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3D Hair Strokes/ Combo Eyebrows
Customer Waiver and Release Agreement

I understand that I will be receiving a permanent cosmetic procedure, 3D Hair Strokes/Combo Eyebrows, which enhance the eyebrows.   

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I understand this procedure have had results for some clients that have lasted up to more than 12 months for 3D Hair Strokes, and up to 3 years for combo eyebrows, but I understand results vary and that no timeframe will be guaranteed to me.   

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I understand that this is a cosmetic permanent tattoo and with time, pigments will fade or change depending in part by my metabolism, lifestyle, skin type, medications, age, smoking habits, drinking habits, sun exposure, and use of chemicals (e.g. Retin-A, Glycolic acids, etc.). I understand touch-up maintenance may be required to maintain an appearance I am satisfied with.   
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I acknowledge that no guarantees have been made to me concerning the results of this procedure and agree that the professional recommendation is a “natural look.”  
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I understand that there are known complications of permanent cosmetic procedures. These complications include redness, swelling, puffiness, corneal abrasions, dark patches, allergic reactions, tenderness, infection, or migration. In addition, I understand there is a possibility of hyperpigmentation from a scar, injury, or otherwise.  
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I understand that it is normal to lose coloring during the healing process. I realize that after the procedure, the color will appear darker than it will after the healing process, which may take up to two weeks.  

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I realize that scabs may form, and skin may slough/ flake off following my procedure, and I should not touch these areas during this time. I understand picking at, pulling, or scratching off or otherwise removing sloughing skin may result in loss of color and/or other complications.  
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I understand the nature of the procedure and the possible complications and/or adverse effects that may be caused by applied pigments.  
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I understand that I will receive and will acknowledge pre- and post-procedure instructions and agree to strictly adhere to such instructions. I understand that achieving the results I desire will in part be determined by my compliance to post-procedure instructions.  
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I accept responsibility for approving the color, shape, and position of the pigments that will be applied and will approve such applications prior to the start of the procedure. I also understand the actual color of the pigment may be modified slightly due to the tone and color of my skin and that the elasticity of my skin may result in a slightly different shape from that which I originally approved. I also understand that pigment unpredictably attaches to some areas of the skin more intensely than other areas and may appear darker of lighter than originally intended.  
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I understand that topical anesthetics will be used for my comfort and to enhance the permanent cosmetic procedure and experience. I realize that I may be allergic or have some complications with topical anesthetics. I agree to make any such allergies or complications known prior to the start of the procedure. I will also inform Fabulous Eyebrows Threading of any condition which may make any of the procedure contraindicated including recent hepatitis or pregnancy, medications, health issues, or personal issues.  
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I understand the taking of before and after photographs of procedures may be required and that some photographs may be taken during the procedure. I also understand that photographs may be used in advertising or promotional materials and give permission for such usage.  
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I understand that these tattoos are permanent and tattoo removal is a surgical procedure which may cause scarring and or disfigurement.  

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I have been given an opportunity to ask questions about the procedures, equipment, past experiences, and/or methods to be used as well as the risks and hazards involved, and I believe that I have sufficient information to give this informed consent.  
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By signing this customer waiver and release agreement, I, the client named below certify that I knowingly and voluntarily release Diya Eyebrows Threading and its directors, officers, owners, employees, agents, and representatives from any and all claims from damages for personal injury arising from the application and procedure of permanent 3D Hair Strokes/ Combo Eyebrows, including damages relating to known or unknown complications which may arise during or following the application process including but not limited to claims from negligence. I further release and hold harmless Fabulous Eyebrows Threading from any claims relating to preexisting conditions I have not revealed or changes to those conditions after the procedure. 

I,  certify that I have read and fully understand this customer waiver and release agreement. I hereby authorize Diya Eyebrows Threading to provide permanent 3D Hair Strokes/ Combo Eyebrows onto my own natural eyebrows and skin. In accordance with the terms and conditions set forth in this customer waiver and release agreement.

CLICK HERE FOR THE AFTER CARE INSTRUCTIONS.

Today's Date: 07/14/2020


Signee Information

If No, please let the employee know as you parent will have to sign this waiver.

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By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.