SEMI-PERMANENT BROWS- CONSULTATION FORM
650 Washmill Lake Dr, Tru Salon Suites Unit 103, Halifax, NS B3S 0H8. Artist: Sara Boudreau
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Do you have any Allergies or Sensitivities, including dietary? (List here)
Are you currently on any medications, topical or oral, especially blood thinners? (list here, along with the conditions they are treating)
Have you had/used any recent Exfoliating Treatments (if yes please indicate date)
Have you had any recent Facial Waxing (if yes please indicate date)
Have you used any recent Resurfacing Products (if yes please indicate date)
Have you had any recent Botox or Fillers (if yes please indicate date)
Have you had any recent Sun Exposure (if yes please indicate date)
Have you had any recent Surgery (if yes please indicate date)
Are you pregnant or breastfeeding?
Yes No
Do you have, or you had, any of the following: (PLEASE READ CAREFULLY & THOROUGHLY)
Cancer Eczema Psoriasis Skin Conditions Rosacea Acne Melasma Diabetes Hepatitis Pigmentation Thyroid Condition Infectious Disease Poor healing of wounds Keloid (raised) Scars Hemophilia Herpes HIV Epilepsy Prolonged Bleeding Pacemaker Heart Problems Prone to Scarring Liver Disease
Do you have Autoimmune Disease? (please identify)
Do you have any other medical conditions or disease not listed above? (please indicate here)
I understand that during subsequent visits it is my responsibility to inform the technician of any updates to the answers I have provided on this form.
I certify that the information above is true & correct and I have not withheld any information requested on this form. I understand that it is my responsibility to inform the technician of any medical or health conditions, as they may affect my treatment. Failure to answer truthfully may result in personal injury. My signature below constitutes my consent to treatment. I hereby give my consent and authorization voluntarily. I release this establishment and its agents from liability for any injury, loss or damage that may result from any information I have withheld.
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Please read the following carefully & initial:
Depending on the skin structure, after the first treatment, small flakes with a loss of some pigment may occur and color intensity may change. Treatments require a final Touch-Up to achieve optimal results. In the first seven days brows are up to 40% darker and 10-15% thicker than the healed results. This will subside and look more natural once fully healed. The final result cannot be determined until brows are completely healed, around 6 weeks. Upon completion of the procedure there might be swelling and redness of the skin, which will subside within 1-2 days. You may resume normal activities following the procedure, however, using cosmetics, excessive perspiration and exposure to the sun should be avoided until the skin has fully healed. The procedure results will look acceptable to appear in public without additional make-up on or around the brows. I agree to follow the After Care Instructions provided perfectly in order to ensure my satisfaction with the final results. I understand that my technician will be taking photographs before and after the treatment for record keeping and liability purposes and that this is necessary if I am to undergo the procedure. These photos may be shared on Lash Perfect social media accounts and if I wish to remain anonymous I have the right to request my identity be hidden (close-up of brows & eyes only.)
Initials
SEMI-PERMANENT BROWS- BASIC INFORMATION
- Microblading & Powder Brows are forms of tattooing. We are implanting ink below the surface of the skin with amanual tool or machine. There may berisks associated with this procedure.
- The treatment is semi-permanent and may fade over time. It is necessary to have the color refreshed, usuallyonce a year. (Longer for Powder Brows.)If you are returning with strokes and shape still visible, it is considered a“Refresh.”
- Those with oily skin mayneed to return sooner for refreshing (between 6-8 months for Microblading.)For thisreason the Powder Brow is the preferred technique for oily skin. It will last longer and age better thanMicroblading for this skin type.
- Semi-Permanent Brows require2sessions. For best results, clients will be required to return forare-touchappointment. This will take place6-8 weeks after the initial procedure and is included in the cost.
- Please be aware that color intensity will be significantlydarker and sharper immediately and for a few days afterthe initial procedure, but the color will reduce byabout 40%.
- Althougha topical anestheticis used during the procedure, sensitivity or discomfort may still be felt. Skin maybe red and/or swollenafter the procedure.
- Please do not drink alcohol24 hours prior to the treatment, or caffeine the day of the treatment. Please refrainfrom exercise the day of the treatment. All of these can increase blood flow in the body and this can cause excessivebleeding. If there is excess bleeding during treatment we may not be able to finishthe procedure.Unless medically necessary, please avoid taking things that thin the blood like fish oils, herbals, Vitamin E, aspirin.
- Please do not shape or wax your browsfor at least 2 weeks prior tothe procedure.
- AHA products and retinoids should be avoided for 2 weeks prior to the procedure (resurfacing or anti-agingproducts generally contain these ingredients.)Botox and Fillers may not be used within 2 weeks before/aftertreatment either.Exfoliating treatments such as microdermabrasion should not be performed within 2 weeks priorto procedure.Chemical and laser peels should be avoided no less than 6 weeks prior to procedure.
- Hormone therapies can affect pigmentation and/or cause sensitivity.
- Discontinue use of any brow-growth serums like Latisse, as it can cause sensitivityandaffect pigment
- The following medical conditions require a note from your doctor giving consent: Diabetes, Auto-Immunedisease,andany other medical condition that causes slow healing or a high risk of infection.It is possible thatcertain medications and pre-existing health conditions may interfere with the healing process or putyouatincreased risk of complications, this iswhy aconsultation with a health professional before receiving a body artservice isnecessary.
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SEMI-PERMANENT BROWS- DISCLOSURE & CONSENT FORM
I understand this is a semi-permanent makeup procedure that may fade over time. Typically it will last 1- 3 years. It will require follow-ups and touch ups to maintain desired results. One complimentary touch up is included in the treatment. It must be scheduled 4 to 8 weeks after my initial treatment. I have read and understand the Fees & Policies sheet. I understand how long the pigment lasts depends on many factors, including my skin type, age & lifestyle, as well as hormones, health & medications. I understand that with oily skin types, Microblading strokes can heal less crisp, expanded & blurry, grey, or may result in a powder effect. For this reason the Powder Brow (machine shading) is the preferred technique for oily skin. It will last longer and age better than Microblading for this skin type. Some skin types may require a 3rd touch up to achieve desired results.
My post-treatment care at home will determine in great part the successful outcome. For this reason there is no warranty or guarantee made to me as a result of this procedure and the final result cannot be guaranteed. There are no refunds for this procedure, as results will vary and individual results are not guaranteed. I accept the responsibility for determining the shape and position of the brows as agreed during the consultation and pre-draw.
I understand the permanent skin pigmentation procedure carries with it known and unknown complications and consequences associated with this type of cosmetic procedure, including but not limited to: infection, scarring, inconsistent color, and spreading, fanning or fading of pigments. There may be discomfort and pain during this procedure. There is a possibility of bleeding during treatment. During and after the treatment temporary swelling, redness and/or itching may occur. During the treatment, despite technician’s expertise and all the precautionary measures, injury is possible. Despite the application of the most advanced and the top quality pigments, allergic reaction is rare but possible. Allergic reaction to the anesthetic is possible. I agree to seek medical attention if complications are suspected or developed.
Though semi-permanent, the pigment may last permanently and may not fade. Surgical procedures may be required to remove pigment from skin. These procedures could cause scarring and permanent damage to the skin. I understand that if I have any skin treatments, injectables, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my pigment. I acknowledge some of these potential adverse changes may not be correctable.
I understand my technician is obligated to, and will, perform treatment in strict compliance with all hygiene and health protection measures as regulated by Health Canada. The highest standards of hygiene are met and sterile, disposable needles and pigment containers are used for each individual client, procedure and visit.
I fully understand the procedure and give permission to my technician to perform the service of Semi Permanent Brows and all procedures and steps involved.
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SEMI-PERMANENT BROWS- FEES & POLICIES
An online consultation (through messaging or email) is offered prior to having the service. This consists of your answering relevant health-related questions to ensure it is safe for you to have the treatment done. You will be asked to provide clear and up close photos of your brows without makeup.
If you prefer to have a live consultation in person at the studio the cost is $30 + tax. During this appointment we will take measurements and do a sketch of the shape which we would use as an outline for the actual treatment & fill the brows with makeup. The cost of the live consultation will be subtracted from the cost of your treatment, should you decide to proceed.
The cost of the procedure includes the Initial Session and the Finishing Touch-Up, preformed 6-8 weeks later. A $100 Booking Fee is required to schedule your treatment, but will be subtracted from the cost of your treatment.
If you cancel the appointment with more than 2 weeks notice, your deposit will be refunded.
With less than 14 days notice, the Booking Fee is non-refundable.
We do understand that schedules sometimes change- if this is the case and you need to reschedule your appointment, you may do so and transfer your deposit as long as it is with 7 days notice. Rescheduling within less than 7 days will require a new Booking Fee for rebooking.
Scheduled appointments for the Finishing Touch-Up also require 7 days notice for cancellation or rescheduling. The Finishing Touch-Up is included in the original price only when performed within 12 weeks after the Initial Session. After 12 weeks, or if appointments are cancelled or rescheduled with insufficient notice, the Finishing Touch-Up will be charged at a rate of $150 + tax.
By signing this form, I am acknowledging that I have read and fully understand the policies.
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SEMI-PERMANENT BROWS- CONSULTATION FORM

SEMI-PERMANENT BROWS- BASIC INFORMATION

SEMI-PERMANENT BROWS- DISCLOSURE & CONSENT FORM

SEMI-PERMANENT BROWS- FEES & POLICIES