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Client Treatment Consent and Release
<br /> This is a semi-permanent procedure to enhance your eyebrows. The eyebrow is shaped with a disposable
<br /> pen, marking the eyebrow to your liking and given approval before procedure starts.The procedure consist
<br /> of a light incision of the top layers of skin. The pigment of color is than placed into the light incisions to
<br /> make a hair like look.
<br /> Notice that inks used are not FDA approved and health consequences are unknown.
<br /> I acknowledge that beauty treatments, the practice of skin care, and the practice of massage, including, but
<br /> not limited to, micro-ablation, microdermabrasion,waxing,electrolysis,facing toning, permanent cosmetics,
<br /> body treatments, ionization, laser treatments, tattoo removal, vein treatments, brown spot removal, Botox,
<br /> Collagen, Dermal fillers, Sclerotherapy, Mesotherapy, Dermaplaning, and various other beauty procedures is
<br /> not an exact science and no specific guaranties can or have been made concerning the outcome. I
<br /> understand that some clients experience more change and improvement than others. In virtually all cases,
<br /> multiple treatments are required in order to realize a difference.
<br /> I also understand and agree to assume the following risks and hazards which may occur in connection with
<br /> any particular treatment including but not limited to: unsatisfactory results, soreness, poor healing,
<br /> discomfort, redness, blistering, nerve damage, scarring, infection, change in skin pigmentation, allergic
<br /> reaction, muscle damage, and increased hair growth. I understand that even though precautions may be
<br /> taken in my treatment, not all risk can be known in advance.
<br /> Given the above, I understand that response to treatment varies on an individual basis and that specific
<br /> results are not guaranteed.Therefore,in consideration for any treatment received, I agree to unconditionally
<br /> defend, hold harmless and release from any and all liability the company and the individual that provided
<br /> my treatment,the insured, and any additional insured,as well as any officers, directors, or employees of the
<br /> above companies for any condition or result, known or unknown, that may arise as a consequence of any
<br /> treatment that I receive.
<br /> I have fully disclosed on my client intake form any medications, previous complications, or current
<br /> conditions that may effect my treatment.I understand and agree that any legal action of any kind related to
<br /> any treatment I receive will be limited to binding arbitration using a single arbitrator agreed to by both
<br /> parties.
<br /> Client Signature: Date:
<br /> Print Name:
<br /> Are you at least 18 years of age? Age:
<br /> Model Release
<br /> In consideration for treatment received, I herby grant permission to the individual or company that provided
<br /> my treatment to use any photographic treatment records for the purposes of clinical and statistical studies,
<br /> advertising,or promotion without any additional compensation to me.
<br /> Client Signature: Date:
<br /> Print Name:
<br /> Are you at least 18 years of age? Age:
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