ENVI Nails & Beauty
Semi-Permanent Makeup

First Name *

Last Name *

Date of Birth * +

Street Address *

Address Line 2

City *

Postcode *

Phone Number *

Email Address

MEDICAL

Doctor's Name *

Doctor's Phone Number *

Please list any medication you have been taking over the last 6 months:

I confirm that the above information is correct.

General Consent and Procedure Permit
Please read these statements carefully:

• Permanent cosmetics are a form of tattooing.
• Re-touch procedures will be required.
• A healing period of 4-6 weeks is required before a re-touch procedure can be performed.
• On rare occasions the pigment may migrate under the skin.
• Applications of the permanent cosmetics may be uncomfortable.
• The pigments will fade.
• Immediately after the procedure, the pigment can be 30 to 50 percent darker than the desired result.
• There may be immediate or delayed allergic reaction to pigments. However, allergic reactions are extremely rare.
• A negative allergy test result will not guarantee that you will not have to have an allergic reaction.
• Allergic reactions to anesthetics can occur.
• Permanent cosmetics cannot be applied to pregnant or nursing mothers.
• Permanent cosmetics cannot be applied to any person under the age of eighteen.
• Infections can occur if the aftercare instructions are not followed correctly.
• There may be swelling and redness following the procedure.
• You may experience minor bleeding.
• It is recommended that clients receiving treatment for eyeliner should have someone drive them home.
• Corneal abrasion may occur during eyeliner procedures. However this is extremely rare.
• Clients receiving lip procedures who have had previous problems with cold sores/herpes may have an outbreak following the procedure. Anti herpes medications is available over the counter or on prescription and has been shown to minimise such outbreaks.
• Lip procedures may appear dry and flaky for up to one week following the procedure.
• If you have an MRI scan within 3 months of your cosmetic procedure we recommend that you discuss this with your doctor.
• Possible scarring, inconsistency of colour and loss of eyelashes may occur.

• A complimentry top up is included with new treatments only and must be carried out 4-8 weeks after the initial appointment. A charge will be applicable after this time frame.

I have read and understand the above statements and the information associated with the risks of Permanent cosmetics.

Topical Anaesthetic Form

Allergic Reaction
Allergic reaction can occur from any anaesthetics used during the procedure. If you do suffer from an allergic reaction you should contact your doctor immediately. Allergic reaction response may display redness, itching, swelling, a rash, blistering, dryness or any other symptoms associated with allergy.
Numbness
We cannot accept responsibility if the treatment area does not numb. Each individual is different according to the skin type. Some clients have reported that the area is totally numb while others say they experience some discomfort.
Procedure
For all procedures a cream or gel topical anesthetic is used. These products are perfectly safe, and can be purchased over the counter from any chemist. The anaesthetic is placed over the treatment area for 10-30 minutes then carefully removed prior to treatment.

As a result of the treatment, combined with the use of the anaesthetic you can expect to experience swelling and redness that could last between 1-4 days. You should always follow your postprocedure instructions.
For Eyeliner procedures you will be asked to keep your eyes closed throughout the numbing procedure. If for some reason the anaesthetic gets into the eye you must inform the technician at once. It is not harmful to the eye although you will experience some stinging and slight discomfort. The cream will be removed and your eyes immediately flushed with a sterile saline solution. It is then safe for the technician to re-apply the anaesthetic.

NOTE: If you experience stinging in the eyes and do not inform your technician immediately, the anesthetic may numb the eyeball, and a possible corneal abrasion may occur. This can result in temporary streaming and light sensitivity of the eyes. You may be unable to open your eyes and each time you do it may be painful, and temporary blurry vision may occur. Corneal abrasion however is rare. If you experience any of these symptoms, inform your technician and visit your doctor immediately.

I have read and fully understood the above risks involved with the use of topical anesthetic and consent to the use of the anaesthetic for the permanent cosmetic procedure.

1. I (your name) *

hereby authorise Hienie Huynh of ENVI Nails & Beauty to perform upon myself the following procedure(s) *

Ombré Brows

Microblading Eyebrows

Gloss and Go™ Lips

Semi-permanent eyeliner

clear

Date * +

Report abuse

ENVI Nails & Beauty LTD

133 High Street

Brentwood

Essex

CM144RZ

01277201007

ENVI Nails & Beauty Semi-Permanent Makeup

ENVI Nails & Beauty
Semi-Permanent Makeup