Babe with Blade, Inc.                                               Microblading Consent & Release Form
By booking an appointment you acknowledge having read and agree to both the Booking Policy and Pre- Treatment Instructions.
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I understand that I will be receiving a semi-permanent cosmetic procedure, 3D Hair Strokes/ Microblading/  Combo/ Powder Eyebrows, which enhance the eyebrows. *
Required
I understand that this is a cosmetic semi-permanent tattoo and while, with time, pigments can and will fade or change according to metabolism, lifestyle, skin type, medications, age, smoking, alcohol, sun exposure, and use of chemicals such as Retin- A and Glycolic acids, they are semi-permanent. Touch-up maintenance work will be expected in the future to keep it looking fresh. *
Required
I understand this procedure has had results for some clients that have lasted up to or more than 12 months (3D Hair Strokes) up to 3 years (combo/powder eyebrows), but these results vary and I understand that no timeframe is guaranteed to me. *
Required
I understand that the professional recommendation is a “natural look.” I acknowledge that no guarantees have been made to me concerning the results of this procedure and that there is a strict NO REFUND policy. *
Required
I understand that there are some common possible complications of semi- permanent cosmetic procedures including redness, swelling, puffiness, corneal abrasions, dark patches, allergic reactions, tenderness, infection, migration. In addition, I understand that there is a possibility of hyperpigmentation or scarring resulting from a procedure, especially in individuals prone to hyperpigmentation from a scar or other injury. *
Required
I understand that it is normal to lose approximately 1/3 of the color during the healing process. I realize that after the procedure the color will appear to be darker and that in about 7 days the color will appear to change and that after about 10 days the color will appear in its final form and will appear softer. *
Required
I realize there will be a period of time when scabs may form and the skin may slough/flake off and that I am not to touch the areas during this time. Picking at, pulling or scratching off or otherwise removing sloughing skin may result in loss of color. *
Required
I understand the nature of the procedure and possible complications or adverse effects that may occur as a result of applied pigments. *
Required
I understand that I will receive and will acknowledge pre and post procedure instructions and agree to strictly adhere to such instructions. I understand that achieving the results I desire will, in some measure, be determined by my compliance to aftercare instructions. In the event I fail to adhere to aftercare instructions, I understand that there is a strict NO REFUND policy. *
Required
I accept responsibility for approving the color, shape, and position of the pigments that will be applied and will approve such applications before the procedure begins. I understand that actual color of pigment may be modified slightly due to the tone and color of my skin and that because of the elasticity of the skin the shape may change slightly from that which I originally approved. I also understand that pigment unpredictably attaches to some area of the skin more intensely than other areas and may appear darker or lighter than originally intended. However, I know that every effort will be made to make the final result flawless. *
Required
I understand that topical anesthetics will be used for my comfort and to enhance the semi-permanent cosmetic procedure and experience. I realize that there are some people who are allergic to topical anesthetics and will make any such allergies or problems known prior to procedures. I will inform Babe with a Blade, Inc. and Nicole DaCosta of any condition which may make any of the procedures contraindicated including recent hepatitis or pregnancy, medications, health issues, or personal issues. *
Required
I understand the taking of before and after photographs of procedures maybe required and that some photographs maybe taken during the procedure. I also understand that exceptional photographs or results may be used in advertising or promotional materials and give permission for such usage. *
Required
I have been given an opportunity to ask questions about the procedures, equipment, past experiences, and/or the method to be used as well as the risks and hazards involved and I believe that I have sufficient information to give this informed consent. *
Required
Consent Form Acknowledgment
By signing the customer wavier and release agreement, I the client names below certify that I knowingly and voluntarily release Babe with a Blade, Inc. and Nicole DaCosta and it’s directors officers owners employees agents and representatives from any and all claims for damages for personal injury arising from the application and procedure of semi- permanent 3D Hair Strokes/ Combo/ Powder Eyebrows including damages relating known or unknown complications which may arise during or following the application process including but not limited to claims from negligence. I further release and hold harmless Babe with a Blade, Inc. and Nicole DaCosta from any claims related to preexisting conditions I have not revealed or changes to those conditions subsequent to the procedure.  I (client listed below) certify that I have read and fully understand this customer wavier and release agreement. I hereby authorize Babe with a Blade, Inc. and Nicole DaCosta to provide semi- permanent 3D Hair Strokes/ Combo/ Powder Eyebrows onto my own natural eyebrows and skin, in accordance with the terms and conditions set forth in this customer wavier and release agreement.
Name (by typing your full name you are acknowledging that this is an E-signature and that all information provided in true) *
Date of Service *
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Phone number *
Client Medical History Form
Do you presently have or previously had any of the following: (check box if yes) *
Required
Chemical Peel (last treatment)
Clear selection
Cancer (year)
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Chemotherapy/ Radiation
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Tumors/ Growth/ Cysts
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Any diseases or disorders not listed?
Clear selection
Name (by typing your full name you are acknowledging that this is an E-signature. You agree that all the information listed in the above "Client Medical History Form" is true and accurate to the best of your knowledge. *
By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by my mere presence within this establishment and that such exposure or infection may result in personal injury, illness, permanent disability, and death.  I understand that the risk of becoming exposed to or infected by COVID-19 may result from the actions, omissions, or negligence of myself and others, including , but not limited to, employees, volunteers, and program participants and their families.  I hereby release Babe With A Blade, Inc. from any and all claims arising from or in connection with any direct COVID-19 impact while visiting. *
I have not traveled nor have I been exposed to anyone that has tested positive in the last two weeks. *
Client’s Temperature *
How did you hear about us? *
Referral name
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