Setra Ink Studio- Microblading Consent Form

Microblading Consent Form

This is a legal document. Please read it carefully.
Client Information
Full Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Phone Number

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pre-Procedure Questionnaire
Are you under the influence of drugs or alcohol?

YesNo
Do you have a communicable disease?

YesNo
Health Conditions (please check all that apply)

Are you currently taking any blood thinnersDo you have a thyroid condition?Do you use Retinol/Retinoids?Do you use Accutane?Are you taking any medication on a daily basis?Do you have any medical condition not mentioned in this form?Do you have any skin condition?Do you have diabetesDo you have any cardiovascular diseaseDo you suffer from EpilepsyNone of the above
*If Yes for any of the above conditions, please explain:
Disclaimer: Please note: If you are currently taking blood thinners, you may not be elegible for microblading without written clearance from your physician. Blood thinners can increase bleeding during the procedure, affect pigment retention, and compromise healing. Aspirin (including " Baby Aspirin", and NSAIDs like Advil or Aleve are considered blood thinners. These medications may require doctor clearance before microblading. Initial below to confirm you have read and understand this policy (even if it does not apply to you).*
* Disclaimer Initials*

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Skin type

NormalOilyDryCombinationAcne-proneSensitive0ther
*If responded other please explain
Skin conditions (e.g. Rashes, eczema, infection, psoriasis, freckles, etc.)
If yes, please identify the condition.
If there is anything to know about your current skin, please explain:
Are you currently taking any medication?

Yes*No
* If Yes, please list:
Are you currently pregnant or nursing?

Yes- PregnantYes-NurseningNone of the above
Any known allergies ?
Have you previously had semi permanent make up done ? If YES, when was it performed?
Above, you can see how we ensure your eyebrows are mapped and designed to perfectly suit your face. Microblading is never a one-shape-fits-all process--every client's brow are tailored to their unique features. During the pre-draw, your brows may look differently than the final result. This is because we use a combination of of black and white pencils to mark the exact areas needed to guide the procedure and achieve the most natural, flattering outcome.
Please take a photo of your natural eyebrows without any makeup. The photo should be taken by facing directly toward the camera, in bright, natural lighting.*
Acknowledgment and Waiver

Please click below to confirm you have read and fully understand the following:
1.*

I understand that this procedure is a permanent change to my skin and body.
2.*

I allow my procedure to be photographed and used for Setra Ink Studio portfolio purposes.
3.*

I acknowledge that the Setra Ink Studio does not offer refunds.
4.*

I acknowledge that Setra Ink Studio cannot determine in advance whether I may have an allergic reaction to the pigments, tools, or products used.
5.*

I understand that bleeding during the procedure can affect the final healing result. To minimize risk, I agree to avoid alcohol 48 hours before my appointment. Excessive bleeding is beyond the control of the technician, and charges still apply.
6.*

Microblading is a form of cosmetic tattooing intended to last an average of 6-18 months. In rare cases, the pigment may migrate under the skin. I understand this is uncommon but a possible risk and I accept it.
Aftercare & Responsibilities
1.*

I understand that I must follow all aftercare instructions provided by Setra Ink Studio, and will receive an instruction card as a reminder.
2.*

I agree to avoid gym workouts, sweating, swimming, saunas, and heavy exercises for at least 7 days after the procedure.
3.*

I acknowledge that failure to follow aftercare instructions may increase my risk of infection or poor results.
Risks and Liability
1.*

Microbladding results can heal unevenly or appear in a different color than initially applied . This healing process is beyond our control, and we cannot guarantee specific results or the longevity of the procedure. I acknowledge and accept this.
2.*

Most clients require one touch-up session, which is included, to ensure the brows heal evenly and the desired look is achieved. Some clients may need additional sessions, which are not included and will incur an extra charge of $150 per session (model procedures excluded).
3.*

I understand that individual results vary and Setra Ink Studio cannot guarantee specific outcomes.
4.*

I release and hold harmless Setra Ink Studio and its technicians from any claims, expenses, damages, or liabilities related to this procedure.
5.*

I confirm that the information I have provided in this document is accurate and true.
Signed Date

MonthDayYear
Client Signature*

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Microblading Consent Form

Client Information

Pre-Procedure Questionnaire

Acknowledgment and Waiver

Aftercare & Responsibilities

Risks and Liability