BROWCHARMS LIABILITY & INTAKE FORM

First Name *

Last Name *

Phone Number *

Email *

Street Address *

City *

State/Province/Region *

Zip/Postal Code *

Emergency Contact *

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Phone number *

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CANCELLATION & NO-SHOW POLICY

Every client must have a valid credit card on file. Card information is securely stored in your account and will only be charged if a late fee, cancellation, or no show occurs. By checking this box you agree that you have read and understand our rescheduling and cancellation policies. (Cancellation or rescheduling within 48 hours of your appointment will result in losing your deposit. Same day cancellations & No Shows will be charged the remaining balance of the scheduled service.) *

I Agree

Card number *

Expiration *

Billing zipcode: *

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CVC *

IF CLIENT IS A MINOR (10-17 yrs old)

Parental consent is required for clients under the age of 18. I guarantee that I am the client's parent and or legal guardian, and I am signing this release on behald of myself and the client.

Are you under 18 years of age? *

I am a minor seeking services with parental consent

I am not a minor

Please provide a photo of your parent or legal guardian's Driver's license. *

Parent/Legal Guardian Signature: *

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Client Consent

Please select all services you will be receiving- *

Beauty Services (Non-Tattoo)

Cosmetic Tattoo

I consent to the following beauty services: *

I consent to the following cosmetic tattoo services: *

Cosmetic Eyebrow Tattoo

Cosmetic Eyeliner Tattoo

A copy of your ID /License is required by law to receive any cosmetic tattoo service. Please upload a photo here. *

Please read the statements below and indicate that you understand and agree to each one. *

I understand that no guarantees can be provided regarding this procedure, final outcome can not be assured.

I recognize that it is my responsibility to verbally communicate any concerns to my technician prior to the start of the procedure.

I understand that cosmetic tattooing carries with it known and unknown complications associated, including but not limited to; is a risk of bleeding, infection, swelling, and allergic reaction to dyes, and risk of infections..

I understand that cosmetic tattooing can be removed with laser treatment , and that removal can cause permanent scarring.

I exempt Browcharms from any liability for injuries that may result from this procedure.

I understand that this agreement applies to this service and all future permanent makeup services performed by my technician and all technicians operating under Browcharms.

Tinting

Associated Risks

Possible risks include allergic reactions, breakouts, skin irritation, and eye irritation. While we take precautions to ensure your safety durign the tinting process, please be aware of these potential risks.

Please check each box to indicate that you understand and agree: *

I understand that tinting brows and lashes can cause irritation to the eye and surrounding areas and can result in stinging/burning, and potential blindness.

I understand that if tint or any other product enters my eyes, my eyes will be rinsed with water and I may require medical attention.

I understand that all hair reacts differently to tint and results do vary.

I understand that this agreement applies to this service and all future tinting services performed by my technician and all technicians operating under Browcharms.

Brow Tweezing/Waxing

Potential Risks: Skin irritation, Breakouts, Skin grazing, and bleeding, ingrown hairs, hyperpigmentation, and bruising. Results do vary depending on how much natural hair the client has. *

I am NOT using Retin A, Retinol, or any form of Vitamin A.( If I am I have halted use for a minimum of 7 days)

I certify that I have not had a Laser peel, microdermabrasion, or any other professional grade exfoliation in the last month.

I certify that I have not used Accutane within the last 6 months.

I consent to this service and understand that this agreement applies to this service and all future brow tweezing and waxing performed by my technician and all technicians operating under Browcharms.

Brow Lamination

Potential Risks Allergic reaction, skin irritation, chemical burns, and hair breakage, eye irritation, and hyperpigmentation. This treatment does require at home care and hair may feel dry and brittle if after care is not followed. *

I understand that some irritation, tingling, and burning can occur when lamination and tinting products come in contact with skin.

I understand that over the course of several weeks, lamination does wear off and brow hair will slowly return to it's natural state.

I understand and agree to follow at home care to keep my brow hair healthy and hydrated after lamination.

I consent to this treatment and understand that this agreement applies to this service and all future brow laminations performed by my technician and all technicians operating under Browcharms.

Lash Lifting

Potential Risks Potential eye irritation, redness, possible allergic reactions, uneven results, and over processing. *

I understand that there may be irritation, itching, pain, and in rare cases eye infection may occur.

I understand and agree to follow aftercare instructions for optimal results.

I understand that this agreement applies to this service and all future lash lifts performed by my technician and all technicians operating under Browcharms.

I understand that there are no guarantees for how long my results last, but on average lash lifts last 6-8 weeks.

I relinquish all rights to hold Browcharms liable for inconsistencies or injury related to this service.

Health History

Do you have any Allergies? *

Yes

No

Please list allergies: *

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Current Medications, Vitamins, & Supplements: ( Please list any and all medications including those for anxiety, depression, blood pressure, thyroid, pain, and sleep aids. This information is important as some medications may affect the healing process or service outcome.) *

Please select all that apply to you: Please consult your physician prior to the procedure if you have concerns regarding a service. *

Skin History *

Please select all skin conditions that apply to you:

If you have Sensitive skin/known allergies and have concerns regarding this procedure, Would you be interested in coming in prior to your appointment for a Patch test? *

YES

NO

To the best of my knowledge, I have provided an accurate list of my medical history. *

I Agree

Previous Work Addendum

PRE- EXISTING permanent makeup- Clients with previous work will need to attach photos here for approval before booking. Browcharms does not specialize in cover up or corrective work. If the pre existing work is too dark, Tattoo removal will be recommended to lighten or fully remove it prior to booking with us. *

I understand

I understand that there is a risk that the brows will not heal properly due to previous ink and possible scar tissue from my original artist. I relinquish all rights to hold Browcharms accountable for inconsistencies. *

I understand

I understand that I will forfeit my deposit and be turned away if I did not let my artist know of my previous work prior to coming in for my appointment. *

I understand

Please upload a clear photo in good lighting of your previous permanent makeup- *

Pre- Appointment Guidelines

I will NOT have Caffeine or alcohol 24 hours prior to my appointment. I will not consume fish oil, anticoagulants, or blood thinning drugs 4 days prior to my appointment. My appointment will be rescheduled for failure to adhere to the pre appointment protocol, and my deposit will be forfeited. *

I agree and understand

Are we a good match? Permanent makeup services involve a shared effort between artist and client to achieve the best result. We will determine if we're the right fit based on your desired outcome and willingness to be involved in the process. We recognize that our services may not be suitable for everyone. If we feel that we are not the best choice for your needs, we will let you know and help you consider other options. *

I Agree

Aftercare Commitment /Touch up

I acknowledge that It is my responsibility to follow the aftercare instructions provided by my technician that can reduce or prevent any adverse reactions. This includes allowing scabs to fall off naturally, applying Aquaphor as recommended, and avoiding excessive sweating, and sun exposure. Should I have any further questions about aftercare I will contact Browcharms promptly via email or text. I confirm that I have read and understood aftercare requirements for this procedure and agree to follow them. *

I Agree

Part 2 (or Touch up) Is included in the cost of cosmetic brow tattoo services for client with no pre existing work (Permanent Eyeliner is not included). Part 2 is required for optimal results. I understand that I am responsible for booking my touch up session and it needs to be scheduled to happen 6-8 weeks after my initial session. I understand that I will be assessed an additional cost if my Touch up session is outside of the 8 week window. (Part 2 is not included for retuning clients coming in for annual refresh touch ups.) *

I understand and agree

Media Release & Consent Form

I authorize the capture of photographs to track the effects of the treatment, and understand that these are required for insurance purposes. *

I Agree

I grant permission for any photos taken today to be used on Social Media platforms for promotional purposes by Browcharms LLC, for future marketing endeavors. *

I Agree

I Disagree

Acknowledgment of Business Policies & Agreement

By checking the boxes below, I agree to the following: *

I agree that I have carefully read and fully understand the preceding statements, and I have had ample opportunity to discuss any questions I may have.

I have read and understand ALL of Browcharms' Business Policies.

I am aware of Browcharms No Guest Policies and will arrive at my appointment unaccompanied.

By Signing below you confirm that ALL INFORMATION YOU HAVE PROVIDED IS ACCURATE TO THE BEST OF YOUR KNOWLEDGE, AND THAT YOU GIVE YOUR CONSENT TO RECEIVE THE SERVICES YOU HAVE REQUESTED. *

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