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Consent Form (Microblading)
Studio: [Studio Name]
Artist: [Artist Name]
Client: [Client Name]
Appointment: [Appointment Date] at [Appointment Time]
Client Information
•Phone: [Client Phone]
•Email: [Client Email]
•Date of Birth: [Client Dob]
Brow Details
•Technique:
Microblading (hair strokes)
Combination brows (strokes plus shading)
Other: [Technique]
•Pigment Color: [Pigment Colors]
I approve the brow shape that was mapped and drawn on before the procedure. I looked at it in a mirror and I'm happy with the shape, thickness, and placement.
Patch Test
•Patch test completed?
Yes. Date: [Patch Test Date]. Result: [Patch Test Result]
No. I declined or waived the patch test, and I accept the higher risk of an allergic reaction.
I understand that a patch test lowers, but does not remove, the risk of an allergic reaction.
Healing and Expectations
I understand my brows will look darker, sharper, and thicker for the first several days. This is normal.
I understand that while they heal, my brows may flake, look patchy, or seem to fade away in spots. Color often comes back over the next few weeks.
I understand the final result isn't visible until healing is complete, usually 4 to 6 weeks.
I understand that a touch-up 6 to 8 weeks after the first session is standard and part of the process. Touch-ups may be charged separately.
I understand that oily skin, large pores, and thin or mature skin may hold pigment less well. Strokes may blur or soften, and my artist may suggest a shading technique instead.
I understand microblading fades over time. Sun, skincare acids, and retinol can speed up fading. I'll need maintenance appointments to keep my brows fresh.
I understand that faces aren't perfectly symmetrical, and perfectly matching brows can't be guaranteed.
If I have old brow tattooing or PMU, I understand that working over it may change the result in ways that can't be fully predicted.
I agree to follow the aftercare instructions. I won't pick, scratch, or peel the flakes.
Risk Acknowledgement
I understand risks include infection, scarring, allergic reaction, blurred strokes, pigment migration, uneven fading, and color change over time.
I have been told that cosmetic pigments may affect MRI images. I will tell medical staff about my microblading before an MRI.
I understand that no specific result can be guaranteed.
** I consent to before and after photos for the artist's portfolio and marketing. I can say no without it affecting my treatment.
Medical Screening
•Accutane in the past 12 months?
Yes
No
Many artists won't microblade within a year of Accutane. Ask your prescribing doctor.
•Retinoids (Retin-A, tretinoin, retinol) used on or near the brows?
Yes
No
Your artist may ask you to pause these near the brows before your appointment. Talk to your doctor before stopping anything prescribed.
•Blood-thinning medications (aspirin, warfarin, etc.)?
Yes
No
Don't stop a prescribed medication without talking to your doctor.
•Botox or fillers in the brow or forehead area in the past 4 weeks?
Yes. Date of last treatment: [Botox Date]
No
•Pregnant or nursing?
Yes
No
Microblading is generally not recommended during pregnancy or while nursing. Talk to your healthcare provider.
•Keloid or raised scarring history?
Yes
No
•Skin conditions in the brow area (eczema, psoriasis, rosacea, dermatitis)?
Yes, describe: [Skin Condition Details]
No
•Known allergies (latex, pigments, topical numbing creams)?
Yes, describe: [Allergy Details]
No
•Autoimmune conditions, diabetes, or immunosuppressant medications?
Yes
No
Other relevant medical information::
I certify that I have answered these questions truthfully and to the best of my knowledge.
My decision to get microblading is my own, and I consent to the procedure described above.
Client Signature: ______ Date: ______
Artist/Staff Signature: ______ Date: ______