||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. The general nature of cosmetic tattooing as well as the specific procedure to be performed has been explained to me.PROCEDURE(s): SEE APPOINTMENT EMAIL
NO. OF VISITS REQUIRED: 2 COST OF PROCEDURE(s): $500I have been informed of the nature, risks, and possible complications and consequences of permanent skin pigmentation. I understand the permanent skin pigmentation procedure carries with it known and complications and consequences associated with this type of cosmetic procedure, including but not limited to: infection, 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 contacts too soon after any 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 skin pigmentation procedure(s), and accept the permanence of the procedure as well as the possible complications and consequences of the said procedure(s).
There is a possibility of an allergic reaction to pigments. A patch test is advisable however it does not ensure a client will not have an allergic reaction. I consent (initial) or waive (initial) the patch test. If waived, I release the technician from liability if I develop an allergic reaction to the pigment. 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.
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. If I am on any medication for depression or any other mood altering prescription, I will advise my technician. If I have ever had cold sores, I will consult with and strictly follow my doctor’s instructions before contemplating any permanent cosmetic procedure around my lips.
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 cosmetic tattoo work done.
This form is designed to give information needed to make an informed choice of whether or not to undergo a 3D Eyebrow, Microblading, semi-permanent makeup application. If you have any questions, please don’t hesitate to ask.
Although BX LASHES is effective in most cases, no guarantee can be made that a specific client will benefit from the procedure
This is the process of inserting pigment into the basal layer of the epidermis. It is a form of tattooing, though semi-permanent. All instruments that enter the skin or come in contact with body fluids are disposable, and disposed of after use. Cross contamination guidelines are strictly adhered to. Generally, the results are excellent. However, a perfect result is not a realistic expectation. It is usual and advised to expect a Touch-Up after healing is completed.
Initially the color will appear more vibrant or darker compared to the end result. Usually within 5-7 days the color will fade 40-50%, soften and look more natural. The pigment is semi-permanent and will fade over time. Additional Touch-Ups are likely needed within 6 months to 2 years.
Photography Release Consent:
We would like your permission to use these photos for advertising. For example: Portfolios, online and print ads, etc. Your consent is necessary regarding this. By signing you are indicate with your signature if you would like your photos used for advertising.
I, THE UNDERSIGNED, HEREBY FULLY RELEASE, WAIVE, COVENANT NOT TO SUE, AGREE TO HOLD HARMLESS, AND FOREVER DISCHARGE my BX Lashes Trained Professional, BX Lashes, DBA,their affiliates, agents, employees, officers, directors, independent contractors, and any and all partnerships, corporations, or companies associated with them, from any and all liabilities, demands, claims, losses, injuries, or damages, including court costs and attorneys’ fees and expenses, of any nature arising out of or relating to the application of semi-permanent eyelash extension products, EVEN THOUGH CAUSED IN WHOLE OR IN PART BY A PRE-EXISTING DEFECT, THE NEGLIGENCE (WHETHER SOLE, JOINT OR CONCURRENT), GROSS NEGLIGENCE, STRICT LIABILITY OR OTHER LEGAL FAULT OF MY BX Lashes TRAINED PROFESSIONAL OR OF BX LASHES, DBA, IT IS MY EXPRESS INTENT THAT THE ABOVE RELEASE INCLUDES THE RELEASE OF MY BX Lashes TRAINED PROFESSIONAL AND BX LASHES, DBA (INCLUDING THE INDIVIDUALS AND ENTITIES LISTED ABOVE) FROM THE CONSEQUENCES OF THEIR OWN NEGLIGENCE. It is also my express intent that this Waiver and Release Form shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representatives, if I am deceased, and shall be governed by the laws of the State of CALIFORNIA. I further agree that, should I choose to seek the advice of an attorney regarding said release, I will be responsible for any and all costs of legal services that I incur. I agree that this release shall be in contemplation of any possible damages, either known or unknown at the signing of this waiver and release form, and said damages are specifically waived following the signing of this waiver and release form. I further agree that in the event that any dispute that arises out of or relating to the application of semi-permanent eyelash extension products and/or the terms of this Waiver; Release between me, or anyone acting on my behalf, my BX Lashes Trained Professional and/or anyone affiliated with my BX Lashes Trained Professional shall be resolved by binding arbitration before the American Arbitration Association. The exclusive venue for arbitration against my BX Lashes Trained Professional shall be the city and state in which the BX Lashes Trained Professional resides at the time the arbitration is initiated; provided, however, that should arbitration be initiated against BX Lashes, DBA, in addition to or exclusive of my BX Lashes Trained Professional, the exclusive venue for such arbitration shall be Los Angeles or Orange County, California. I agree that I will responsible for and will pay all court costs, arbitration costs, attorneys’ fees and expenses, and other associated costs incurred by my BX Lashes Trained Professional or BX Lashes, DBA, in seeking enforcement of this Waiver & Release. I further release my BX Lashes Trained Professional from any responsibility for pre-existing conditions I have not revealed, or any consequential change to those conditions that arises subsequent to the procedure. I understand that I am responsible for any medical treatment I may need to receive as a result of getting this procedure. I accept full responsibility for these and any other complications, which may arise or result during or following the eyelash extension procedure(s), which are to be performed at my request. Please read the following statements and sign and date on the line to indicate that you have read, understand, and accept the
I, the undersigned client, certify that I have read and had explained to me and fully understand the above waiver and release form and am signing it voluntarily as my own free act and deed. I certify that I have consulted with an BX Lashes Trained Professional and have read all applicable literature given to me. I accept the explanation of potential complications and risks described herein. I certify I am of sound mind and I am fully capable of executing this waiver and release form for myself. No oral representations, statements, or inducements apart from the foregoing agreement that has been reduced to writing have been made.
I, the undersigned client, acknowledge and fully understand that there might be other unknown risks not reasonably foreseeable at this time. I, the undersigned client, for the purposes of documentation, hereby consent to “before and after” photographs. I, the undersigned client, hereby give BX LASHES, DBA, and its affiliates, the absolute right and unrestricted permission to take, use, and display photographic images of me, through any form of media (print, digital, electronic, broadcast, or otherwise) at any location for art, advertising, media release news articles, marketing, publicity, archival, or any other lawful purpose. I waive any right to royalties or other compensation arising from or related to the use of photographic images of me. I release and agree to hold harmless BX Lashes, DBA and its affiliates from any liability in connection to
taking or using said images. (Optional)
Since we reserve your appointment time especially for you,
cancellations must be made 24 hours in advance for your appointment.
No shows will result of losing your deposit.
-This agreement will remain in effect for the procedure and
all future procedures conducted by BX Lashes.
-I understand that this agreement is binding and I have read
and fully understand all information listed above.
In order to maximize your client’s progress, it is critical that you attend
all treatment sessions. Arriving late or missing appointments impairs
your client’s ability to progress, disrupts staff schedules, limits other
clients’ abilities to get appointments. Please note the following policy:
Since we reserve your appointment time especially for you,
cancellations must be made 24 hours in advance. No shows
will result of the entire appointment amount being charged to
your credit card or to your next appointment.
Since this is a services. All sales and transactions are finals and no refund!