ONCE THE MICROBLADING & NON-REFUNDABLE DEPOSIT CONSENT FORM IS COMPLETED YOU WILL THEN CHOOSE YOUR DATE AND SERVICE(YOUR FORM WILL ONLY BE SAVED AFTER REQUESTING YOUR APPOINTMENT)* Name First Name Last Name Date Of Birth * MM DD YYYY Phone* * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Today's Date * MM DD YYYY Select your Technician's Name * Andreea Furtado Have you had a Chemical Peel in the last 30 days * Yes No Last Botox Treatment: Allergies or Allergies To Medications: Please list Medications/Supplements you're taking: PLEASE READ AND AGREE BELOW * I understand that receiving cosmetic tattooing, including microblading or powder/nano/combo brows, is a form of permanent makeup that carries inherent risks, including but not limited to discomfort, swelling, redness, bruising, infection, poor pigment retention, allergic reactions, scarring, asymmetry, and pigment migration or fading. I acknowledge that: Discomfort may occur even with topical anesthetics. These work differently for everyone. Pigment color may fade or change over time and is affected by lifestyle, skin type, medications, skincare products, sun exposure, tanning, pools, and certain treatments like lasers or plastic surgery. Results are not guaranteed and future touch-ups will be required to maintain color and shape. This procedure is not an exact science but an art, and perfect symmetry or exact results cannot be guaranteed. A touch-up is REQUIRED 8–16 weeks after the initial procedure. This is a separate fee. All touch-up sessions (including yearly maintenance recommended every 24–36 months) are an additional cost. If I cancel or reschedule and do not complete my initial touch-up within 5 months, I will be charged an additional $300–$400. I am over 18, not under the influence of drugs or alcohol, and I elect to receive this permanent makeup procedure. Health & Safety Acknowledgements I will notify my technician if I have allergies to Lidocaine, Prilocaine, Benzocaine, Tetracaine, or Epinephrine. I will inform my technician and medical providers of my permanent makeup, especially before MRI procedures. I understand that if I’m on mood-altering prescriptions or have a history of cold sores (if receiving lip procedures), I must consult my doctor before treatment. I agree to follow all pre- and post-care instructions provided. Failure to do so may affect my results. Office & Cancellation Policies A non-refundable deposit of $100 (Microblading/Combo) or $200 (Powder/Nano) is required to book. **48-hour notice is required for cancellations. Failure to provide this will result in a $100 cancellation fee charged to the card on file.** All clients are required to have a card on file. No-shows or same-day cancellations after the second offense will require future appointments to be paid in full in advance. If I decline the service at my scheduled time, I will still be charged the full service fee. Clients who do not confirm their appointments through our reminders or communication efforts may lose their slot and be charged a cancellation fee. Children under 18 are not allowed in the studio. Non-Refundable Deposit Agreement I understand and agree that any deposits made are: Non-refundable Non-transferable to other clients or services Not applicable as credit for future services I give permission to use of my photos for the purpose of marketing. My pictures may appear in print or online. By signing below, I acknowledge that I have read and understood BR Brows + Beauty’s Non-Refundable Deposit Policy and all associated risks of permanent cosmetic tattooing. I accept full responsibility for my decision to undergo this procedure. I AGREE AND UNDERSTAND THE ABOVE TERMS AND ASSUME ALL RESPONSIBILITY COUPON CODE I give my consent to make this my default Credit card for all digital and in-person payments. * Expiration Date: * Billing Zip Code * Security Code (CVV) REQIRED * Digital Signature * **ONCE APPOINTMENT REQUEST IS ACCEPTED THE CARD WILL BE CHARGED THE DEPOSIT AMOUNT FOR THE SERVICE YOU CHOOSE** Thank you!
