Microblading

The purpose of this consultation is to educate the inquiring client on what microblading is, what to expect from the procedure and to ensure the client is a proper candidate for microblading — not everyone is a candidate. There is also a lot of misleading information on the internet about microblading. This consultation should clear up any questions or misinformation regarding the procedure.

Important things to know:
MICROBLADING IS A TATTOO. It utilizes a manual tool to deposit pigment into the skin to create the look of “hair-like” strokes in the brow area. Although it is referred to as “semi-permanent,” this does not mean that if you have the microblading done and decide you don’t want it anymore, that it will fade completely in 12-18 months as if it never happened. It is a tattoo, therefore pigment from the procedure might remain in the skin indefinitely. However, the
pigment does lighten / fade gradually over time, which is why microblading requires annual “color boosts” to refresh the color and darken strokes that have faded.

Your name

Your email

Date of Birth

Address

List of Medications

Are you currently under the care of a physician, if yes, then why?

Are you currently under the care of a dentist, if yes, then why?

Have you ever had a cold sore?
YesNo
Do you scar Easily?
YesNo
Have you received chemotherapy or radiation in the past year?
YesNo
Have you ever had keloid scar? (a scar that heals raised)?
YesNo
Do you bleed easily?
YesNo
Do you suffer from psoriasis, eczema or dermatitis anywhere on your face?
YesNo
Are you pregnant or nursing?
YesNo
Please select if you have any of the following conditions
Diabetes Type 1 or 2Liver DiseaseAuto-immune diseaseHigh blood pressureNone
Please select if you have any of the following
Hair LossAnemiaDiabetesHIVEpilepsyNone
*Please read the following statements carefully.
Microblading is a way of cosmetic tattooing, intended to be semi-permanent lasting average 12-18 months. The pigment may migrate under the skin, immediately or over time. The procedure may be uncomfortable. Although rare, there might be an immediate or delayed allergic reaction to pigment. A negative patch test result does not guarantee that you will not develop an allergic reaction after the full procedure. Allergic reactions to anesthetic can occur. Permanent cosmetics cannot be performed if you are pregnant or nursing, or anyone under the age of 18. Infections can occur if aftercare instructions are not followed correctly. There may be swelling and redness following the procedure. You may experience minor bleeding. If you have an MRI scan within 3 months after microblading procedure, you should notify/discuss with your doctor.
Possible scarring may occur.
*I have received after care information and I’m fully aware of the after care procedures. I fully understand the
information provided above & confirm that all information provided by me is correct and truthful.

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