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🖌️ MICROBLADING & SEMI-PERMANENT MAKEUP CONSULTATION & CONSENT FORM

TREATMENT OVERVIEW

Microblading and semi-permanent makeup (SPMU) involve the application of pigment into the upper dermis using fine needles or a machine to enhance brows, lips, or eyeliner areas. Pigment fades over time and requires touch-ups to maintain desired results.

Procedure Type:

  • Microblading
  • Powder Brows / Ombre
  • Lip Blush
  • Eyeliner
  • Combination Brows
  • Colour Correction
  • Top-up Only

Treatment Area(s):

  • Brows
  • Lips
  • Eyeliner
  • Other:

MEDICAL HISTORY

Please tick any conditions that apply to you:

  • Pregnant or breastfeeding
  • Keloid/hypertrophic scarring
  • Blood disorders / anticoagulants
  • Epilepsy or seizures
  • Hepatitis B/C or HIV
  • Cold sores (herpes simplex)
  • Eczema, psoriasis, or dermatitis in the treatment area
  • Autoimmune disorders (e.g. lupus, MS, thyroid)
  • Diabetes or healing disorders
  • Previous allergic reaction to tattoo pigment or numbing cream
  • Botox/fillers in the past 4 weeks
  • Chemotherapy or radiation in the past year
  • Use of Accutane (Roaccutane) in the past 12 months
  • Currently taking antibiotics or steroids
  • Under 18 years of age
  • None of the above

Please list any allergies, medications, or other conditions:

Patch Test & Suitability

  • I have completed a patch test at least 48 hours before treatment and had no adverse reaction.
  • I understand that allergic reactions are still possible even with a patch test.
  • I confirm I am over 18 and not under the influence of alcohol or drugs.

Risks & Side Effects

Please check each box to confirm your understanding:

  • I understand this is a tattooing procedure and carries associated risks.
  • I may experience discomfort, redness, swelling, or minor bleeding.
  • Pigment will appear darker at first and will lighten during healing.
  • I understand aftercare will affect final results.
  • Results vary based on skin type, lifestyle, and health.
  • Risks may include infection, allergic reaction, or scarring (rare).
  • A top-up session may be required for optimal results.
  • Pigment may fade or change over time.

Post-Treatment Aftercare

I understand and agree to follow the aftercare instructions below:

  • Keep the area clean and dry for at least 7 days.
  • Do not scratch, pick, or touch the treated area.
  • Avoid sweating, sun, heat, and makeup on the area for 7–10 days.
  • Apply only the aftercare ointment provided or recommended.
  • Healing takes 7–14 days and final results may take up to 6 weeks.
  • I will contact the clinic if any signs of infection or abnormal reaction appear.

Photo Consent (Optional)

  • I consent to before/after photos for treatment records.
  • I consent to use of photos for marketing or social media.
  • I do not consent to photography.

Client Declaration & Consent

Please read and confirm the following:

  • I confirm the information I’ve provided is accurate and complete.
  • I understand the procedure, risks, healing, and aftercare instructions.
  • I understand results vary and no guarantees are made.
  • I understand some fading, colour changes, or asymmetry may occur.
  • I’ve had my questions answered and consent to treatment.

Services

Company

Get in touch

  • 019-9253-8866
  • info@qtbeautyandaesthetic.co.uk
  • 31 Fore St, Hertford Hertfordshire SG14 1DJ