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4100 – Safe Body Art
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PR0541638
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COMPLIANCE INFO
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Last modified
2/29/2024 1:57:47 PM
Creation date
3/31/2021 3:45:10 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0541638
PE
4120
FACILITY_ID
FA0023861
FACILITY_NAME
RENAISSANCE SALON AND SPA (GRAFFIN, ELISABETH)
STREET_NUMBER
111
Direction
N
STREET_NAME
CHURCH
STREET_TYPE
ST
City
LODI
Zip
95240
CURRENT_STATUS
02
SITE_LOCATION
111 N CHURCH ST
P_LOCATION
02
QC Status
Approved
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SJGOV\cfield
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EHD - Public
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6 <br /> i <br /> 'EVER LR ST ICLIG PRE PROCEDURE VICE <br /> BROWS <br /> Please read the following advice carefully and sign at the end. <br /> Microblading procedure normally require multiple treatment sessions. For best results, clients <br /> will be required to return for at least one re-touch appointment.This will take place between 4-6 <br /> weeks after the initial procedure. <br /> Please be prepared that colour intensity will be significantly darker and sharper <br /> immediately after the procedure.This will reduce by 30%-50% <br /> Although numbing cream is used during the procedure, slight sensitivity/ discomfort <br /> can be still felt by sensitive clients. <br /> Delicate or sensitive skin may be red and/ or swollen after the procedure. <br /> Please wear your normal make-up to the salon on the day of your procedure. <br /> Please do not drink alcohol the night before treatment. <br /> Where possible, try to avoid the following herbs and spices running up to your <br /> appointment: Black pepper (Piper nigrum), Cardamom (Elettaria cardamomum), a member of <br /> the Zingiberaceae (Ginger), Cayenne (Capsicum frutescens) Cinnamon (Cinnamomum cassia), <br /> Garlic (Allium sativum), Ginger (Zingiber officinale), Horseradish (Armoracia lapathifolia), <br /> Mustard -A patch test will be performed, unless waived upon request. <br /> Any brow shaping using waxing should be performed at least 48hrs before the treatment. <br /> Electrolysis treatment should be undergone no less that 5 days before the treatment. <br /> AHA preparations should be undergone no less than 2 weeks before the treatment. <br /> Chemical, laser peel retain A should not be performed 6 weeks before the procedure. <br /> Topical anesthetic advice <br /> Allergic reaction: can occur from any anesthetics using during procedure. If you do suffer from <br /> an allergic reaction, you should contact your doctor immediately. Allergic reaction response <br /> may show through redness, swelling, rash, blistering, dryness or any other symptoms <br /> associated <br /> with an allergic reaction. <br /> Numbness: We cannot accept responsibility if the area to be treated does not respond to the <br /> numbing cream. Each individual is different according to skin type. Some clients report the area <br /> to be completely numb, while others may experience some discomfort. <br /> Procedure: For microblading procedure a numbing cream/gel is used. The products are <br /> formulated to be perfectly safe and can be purchased over the counter from any pharmacy/ <br /> chemist. The anesthetic is placed over the treatment area for 20-30 minutes then carefully <br /> removed prior to treatment. As a result of the treatment, combined with the use of the <br /> anesthetic you can expect to experience some redness/ swelling that can last 1 - 4 days. You <br /> should always follow your post procedure advice/after care for the best results. <br /> I have read and fully understood the above information provided and any <br /> risks involved with the use of topical anesthetic and I therefore consent <br /> to the use of the anesthetic for the microblading procedure. <br /> I agree to follow pre-procedure advice closely <br /> Client's Name: Surname: Date: <br /> Therapist's Name Surname: Date: <br /> ©Everlasting Brows Client Consultation Form 2016 <br />
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