Permanent Makeup

Let us do this part

Today's Date:

Mon May 6 2024 04:54

Practitioner:*

Pigments used:*

I release and hold harmless Good Form Piercing & Tattoos Ltd and its employees from all manner of liabilities, claims, damages, or legal action arising from or connected in any way with my microblading, or the procedures and conduct to perform my microblading.

I allow Good Form Piercing & Tattoos Ltd to microblade me. I understand that this procedure will be
performed under proper aseptic conditions, using sterile and/or disposable implements with the highest
quality ink. I understand that infections and/or irritation can occur as a result of improper care and/or poor
hygiene. I agree to follow the procedures as instructed by my artist and/or the aftercare pamphlet I have been
provided with for the recommended period of time.

I further understand that although Good Form has taken extra measures to reduce the risk of transmission of the Coronavirus/Covid 19 (including, but not limited to; not allowing any staff or client that display symptoms to enter), due to the close nature of the procedure, no guarantee can be made that Covid will not be transmitted during an appointment. I understand the procedures taken to protect me, and am comfortable with this level of risk.

Please read and answer

Price Quote*

I confirm that I have received an estimated price or time quote for this service, and have agreed to this total. I understand that due to the nature of tattoos, this price might fluctuate slightly and is not an exact quote.

Covid Check*

Are you experiencing any cold or flu symptoms?
Have you been asked to isolate in the past 14 days?
Have you been in direct contact with anyone who has?

Do you have any Allergies? If yes, please list them.*

Including, not not limited to: medications, adhesives, foods and /or natural products.

Details:

Health*

Are you pregnant or nursing? Do you have any medical conditions that may impact your healing? (Hemophilia, diabetes, etc) Are you on any medications that could affect your healing? (immunosuppressants, accutane, etc)

Details:

Botox*

I have NOT gotten botox injections in the past month.

Design*

I hereby agree that the mapping of my eyebrows (or placement of beauty marks/freckles) has been thoroughly discussed and agreed upon between myself and my artist, and it is henceforth my responsibility to notify and clarify to my artist of any changes in are desired.

Questions?*

Has Good Form given you a chance to ask any and all questions you may have, and answered them to your full satisfaction?

Duress*

I am sober and of sound mind, with no influence of drugs or alcohol I am voluntarily choosing to be tattooed by the artist, without any duress or coercion from my artist, or any third party.

Photo*

I understand that photos must be taken for insurance and comparisons. I hereby allow Good Form to take my photo and keep it for their records.

Posting Photos*

I release the rights to any photographs taken of me and eyebrows, and give consent in advance to the reproduction of these photos in physical prints, online/social media use, or for portfolio purposes.

Instagram

If you have an Instagram account and want us to tag you in any posts with your photos, please leave us your handle!

If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.

Client Information

I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement.

Legal Name:

Pronoun:

Chosen name:

Date of birth:*

You must be 18 or older

Phone #:*

Email:*

Signature:*

Sign above or type signature:

Photo ID*

Please take photo(s) of your government issued photo IDs and related paperwork.

Enter passcode to submit: