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Disclosure & Consent for Microblading

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Please read and complete before your appointment

I have made an informed decision, and fully consent to undergo this microblading procedure. *
I understand that the shape/color for my procedure will be determined during the consultation, and that the technician will not begin the procedure until she and I are both satisfied with the shape. *
I understand that my technician will choose pigments based on the desired healed results, but I will ultimately approve of the choice made. *
I understand that there is no way to predict with 100% accuracy how the pigments will appear once fully healed, as skin texture, tone, etc. play a large role in the overall appearance of the healed results. *
I understand that no guarantees can be made as to the final results, as my technician cannot control how my skin heals. *
I understand that semi-permanent makeup is an art form, not science, and that while the purpose of the procedure is to enhance my natural beauty, perfection is not guaranteed.
I acknowledge the manufacturer of the pigment to be applied requires spot testing and specifically disclaims any responsibility for any adverse reaction to applied pigments. I understand spot testing may identify individuals who develop an immediate allergic reaction to pigment, however, spot testing does not identify individuals who may have a delayed reaction to pigment. *
I agree to (choose one) RECEIVE / WAIVE a spot test prior to my appointment and agree to release my technician, Chibrowtique, assistants, and pigment manufacturer(s) from any and all liability related to allergic reaction or any other reaction to applied pigments. Should you choose to receive it you must schedule a spot test appointment at least 48 hours prior to appointment.
I understand that allergic reactions to pigment are very rare, however, they can and do occur and when they occur they can be serious and especially difficult and very troublesome to treat. *
I undestand that this procedure will involve some level of pain and discomfort. *
Are you pregnant or nursing?*
I understand that the markings are permanent and that there is a possibility of hyper pigmentation or hypo pigmentation resulting from a procedure, especially in individuals prone to hyper pigmentation or hypo pigmentation from a scars or injuries. *
I understand that the description of the procedure is not meant to scare or alarm you. It is simply an effort to make you better informed so that I may give or withhold my consent for this procedure.
I understand that I cannot have a tan/spray tan/sunburn 30 days prior or after the procedure, and if I do have a sunburn/tan/spray tan on my face the technician will have to cancel my appointment and forfeit my deposit. *
I understand that risks involved with the procedure may include, but are not limited to: infections, allergic and other reactions to applied pigments, allergic and other reactions to products applied during/after the procedure, fanning or spreading of pigment (pigment migration), fading of color and other unknown risks. *
I accept full responsibility for any and all, present and future, medical treatment(s) and expenses I may incur in the event I need to seek treatment(s) for any known or unknown reason associated with the procedure planned for me. *
I have been given an opportunity to ask questions about the procedure and the risks and hazards involved and I attest that I have sufficient information to give this informed consent. *
I understand that if I have an infection, adverse reaction, or allergic reaction to the procedure, I must notify the staff at Chibrowtique, a health care practitioner, and the Illinois Department of Health, Drug and Medical Devices Division *
I acknowledge that I have access to the Post Procedure Instructions on this website. I further acknowledge that I understand the Post Procedure Instructions completely and will follow said instructions in their entirety. *
I understand that a follow up procedure 6-12 weeks after my initial procedure is recommended to achieve desired results. *
I understand that additional procedures beyond the followup session, although not common, may be required to obtain the desired results. I also understand that additional session will incur a fee. *
I understand additional touch up appointments may be needed for oily,problematic skin, those with dark pigmented skin and people who do not follow aftercare instructions. There will be an addtional cost for service.
I understand that though not common, an additional appointment may be required before your annual touch up.
I hereby authorize Chibrowtique and its employees to take photographs of the work performed both before and after treatment (this is one of our requirements to have record of your brow transformation) AND I further authorize the use of said photographs to be used for the purpose of social media, and our website, *
I have read over the postcare instructions prior to my appointment and I am aware that I must follow instructions.
I have read all the precare instructions prior to my appointment and followed all the recomendations. This is not a gurantee to perfection as this is a art form.
I agree that if I have a complaint of any kind, I shall notify my technician at Chibrowtique and I agree that any controversy or claim arising out of or relating to this consent and/or any signed contract between myself and Chibrowtique or the breach thereof, shall be settled by arbitration in the state of Illinois in accordance with the rules of the American Arbitration Ass. and the judgement of

My deposit is non-refundable. no refunds will be issued after the procedure is completed for any reason whatsoever. *

Thanks for submitting!

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