52 GREAT GEORGE STREET
weymouth dt4 8nn
Semi Permanent Makeup
Microblading & SPMU Consent Form
Supercilium Brow Henna
Brow & Lash Tinting
Lash Lift & Tint
New Client Consultation Form
Beauty Aftercare Advice
Body Contouring Non-Invasive
Fat Dissolve No-Needle Injections
Fat Dissolve Consent Form
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Dermal Filler No-Needle Injections
Aesthetics Aftercare Advice
Filler Consent Form
Fresh Reality Clinic
Natural Energy Release
Isla Verde Luxury Spa Facial
Wellness Aftercare Advice
Skincare Consultation for Facial
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Earth & Beauty
Terms & Conditions
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Microblading & SPMU Consent Form
Please ensure that you have at least 15 minutes of uninterrupted focus to fill in this form accurately and correctly. All information given is strictly confidential.
In addition to this form, I understand that I am also required to complete a 'New Client Consultation Form' before continuing with this form. This is found via
the website menu.
Date of Birth
I have read and understood the information found on Earth & Beauty's website, and would like to proceed with Microblading or SPMU.
If you have a health condition that may impact your suitability for this procedure and have NOT YET discussed this with Earth & Beauty, please do so before continuing with this form.
I authorise Earth & Beauty to perform upon myself the following procedure: Microblading or SPMU and any top-up procedures. If any unforeseen condition arises in the course of this procedure, calling in Earth & Beauty's judgement in addition to, or different from those now contemplated, I further request and authorise Earth & Beauty to do whatever is deemed advisable and necessary in the circumstances.
I accept responsibility for agreeing with the colour, shape and position of the permanent cosmetic procedure as agreed during my consultation.
I fully understand and accept that non-toxic pigments are used during the procedure and that the cosmetic enhancement achieved may fade over a period of 1-5 years. Even though the colour has faded the pigment will stay in the skin indefinitely.
I have been informed that the highest standards of hygiene are met, and that sterile disposable needles and pigment containers are used for each individual client, procedure and visit.
I understand and accept that each procedure is a process requiring multiple applications of pigment to achieve desirable results, and that 100% success cannot be guaranteed during the first procedure. I understand that it is likely that I will need to return for a re-touch procedure.
I have been informed that eye procedures may stimulate dormant eye disorders or eye infections, and that some medication can prevent absorption of the pigment.
I agree to follow all pre-procedure and post-procedure instructions as provided and explained to me by Earth & Beauty . I confirm that I have access to copies of all the relevant aftercare instructions which can be found on earthandbeauty.co.uk
For the purpose of documentation I also consent to the taking of ‘before’ and ‘after’ photographs of said procedure(s) for record purposes and for use in presentation portfolios, and on Earth & Beauty's website and social media.
Under GDPR rule I understand that I have full access to all data held on me. This data will be held by the clinic for no longer than 6 years for insurance purposes, after which, digital information will be deleted permanently, and paper documents will be destroyed. All information on myself is kept on password encrypted hard drives or locked in filing cabinets to which only selective staff members have access. None of my personal data will be sold or used for anything other than to provide the services of this clinic.
I am over 18 years of age.
The result of the procedure is heavily impacted by the following; medication, skin characteristics – (dry, oily, sun-damaged and thickness), natural skin undertones (blending with chosen pigment), personal pH balance of the skin (which changes from visit to visit), alcohol intake, smoking, post procedure care.
I do not have any physical, mental, or medical impairment or disability that might affect my wellbeing as a direct or indirect result of my decision to have the procedure done at this time.
I am not pregnant.
I am not under the influence of drugs or alcohol while completing this form and agree to not be under the influence of any recreational substances or alcohol on the day of my treatment.
I do not have cancer, or any other conditions impacting my immune system or have had cancer and been in remission for at least 6 months.
Being of sound mind and body, I hereby accept any and all responsibility that might be a consequence from my decision to have any aesthetics and permanent cosmetics procedure performed by Earth & Beauty.
Microblading and SPMU is not suitable for people who have: hyper pigmentation, lupus, skin disorders, scars heavily or prone to keloids, HIV, mitral valve prolapse, haemophilia venereal disease, hepatitis, cancer, radiation/ chemotherapy, epilepsy, infectious disease, respiratory fainting attacks, taking blood thinners/ anti-coagulant, steroids, high blood pressure, excessive sebum.
I do not have any of the above mentioned health conditions impacting my suitability to Microblading or SPMU.
I do have one or more of the above mentioned health conditions impacting my suitability to Microblading or SPMU.
Giving as much detail as necessary, outline your health conditions or treatments that you are currently undergoing that could impact your suitability, procedure, healing and results:
GP Letter Required For: high blood pressure, blood thinners, heart condition, diabetes, haemophilia, allergy to metal, allergy to anaesthetic, psoriasis, eczema or dermatitis, problems healing, epilepsy, seizures or prone to fainting attacks, any other associated health conditions or medications taken that might interfere with the treatment or healing
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I have a condition deemed by Earth & Beauty as high-risk for this treatment, but would like to go ahead anyway. I understand the increased risks involved and accept all responsibility. I am attaching a GP's letter to authorise my suitability for the treatment specifying the medical condition relevant to me and that it is safe to proceed.
Some conditions may result in excessive bleeding during the procedure which may result in reduced pigment retention and consequently a decreased quality of results. I accept this and would like to proceed anyway.
During the Scratch Test, two small scratches will be made in an inconspicuous area of your body (upper arm or back is ideal), each one will test the reaction of the skin to the products used: pigment and lidocaine topical anaesthetic gel. This is precautionary measure and is a compulsory step in having your Microblading or SPMU treatment at Earth & Beauty.
24 hours after the Scratch Test remove the plaster and after 48 hours examine the skin. If there is no reaction, i.e. no redness, swelling, irritation or itching, then it is safe to proceed with the treatment. The colour is for patch test purposes only and the correct colour will be mixed for you at your first treatment. Should you experience any negative side effects, remove the plaster and immediately flush the area with cold water and contact your GP. In the nature of good communication, please also contact Earth & Beauty to report the test results in either scenario.
I understand that an allergy scratch-test does not guarantee that I will not have an allergic reaction to the pigment, but this is done as a precautionary measure regardless and in most cases is an effective precautionary measure.
Allergic reaction can occur from any products 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 symptom associated with allergy.
Earth & Beauty cannot accept responsibility if the treatment area does not numb. Each individual's numbing level differs according to their skin type. Some clients have reported that the area is totally numb while others say they experience some discomfort during the procedure. The topical anaesthetic products are perfectly safe and can be purchased over the counter from any chemist. The anaesthetic is applied on to the treatment area for between 10-30 minutes then carefully removed prior to treatment.
If for some reason the anaesthetic gets into your 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 reapply the anaesthetic to the area being treated.
If you experience stinging in the eyes due to anaesthetic entering the eyes, and do not inform your technician immediately, the anaesthetic 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 contact your doctor immediately.
Alcohol, aspirin, ibuprofen, coumadin and caffeine must be avoided at least 48 hours prior to procedure. Do not discontinue any medication before consulting your doctor. Since delicate skin or sensitive areas may be swollen or red, it is advised not to make social plans for the same day. Please wear your normal makeup to the salon on the day of the procedure. Earth & Beauty does not allow any family or friends to attend with you.
Any threading or hair removal in the brow area should be performed at least 48 hours before any Microblading or BROW SPMU procedure. If you are undertaking electrolysis on the brow area, please ensure that it is no less than 5 days before the procedure.
Be prepared for the colour to be significantly sharper and darker immediately after the procedure. This is completely normal and will subside; becoming lighter as the tissue heals. This process can take up to ten days.
Upon completion of the procedure there may be some swelling and redness of the skin, which will subside within 1-4 days. In some cases, bruising may occur. You can be assured that the procedure, even after only one treatment, looks acceptable enough to comfortably appear in public without additional makeup on the affected area.
Always avoid unnecessary touching, scratching or picking of the treated area. Always wash and dry your hands before and after handling the treated area. If possible, wash your hair in the bath rather than in the shower to avoid getting the treated area wet. Sleep on your back. Swimming, sunbeds and sunbathing should be avoided until the you are fully healed.
Do not use any type of skin products, creams, washes or make-up on the area whilst it is still healing (up to 14 days). Only use Vaseline and the Vitamin A&D Ointment sachets while healing. Healing cream should be applied gently at night, not thickly. This is to prevent drying out and cracking of the skin.
Do not drink alcohol excessively for the first 5 days after treatment. Do not sweat excessively for the first 5 days after treatment.
After approximately two weeks all dryness should have gone and should be replaced with fresh skin at which point the area can become wet during bathing without risk.
I have been advised that the true colour will be seen within 4-8 weeks after each procedure, and that the pigment may vary in colour according to skin tones, skin type, and age and skin conditions. I understand that some skins accept pigment more readily than others and no guarantee to an exact effect or colour can be given.
(Brows Only) Due to natural skin regeneration, after the recovery period brows might appear lighter for a while, before the pigment shows up after the healing process.
(Brows Only) Often, even with proper care customers develop bald spots or lose original hair strokes which could make the brows look slightly uneven. This is normal because each client's skin regeneration is not a process that anyone can control and is a natural occurrence. That's why some clients will need a complementary top-up session after one month to ensure that brows are even and the desired result was achieved.
I understand that a top-up can be done between 1 and 12 months after the initial procedure at a discounted price (within 12 months). After this time, the full top-up price will be charged. I understand it is my responsibility to book the follow-up appointment.
To avoid pigment-fade for as long as possible, avoid excessive exposure to the sun or UV rays and use a good sunscreen or moisturiser with an SPF50.
There are conditions that may result in no pigment retention. One of these is called Pigment Allergy (known to dermatologists as PPD) or an underlying auto immune disease that the client may even be unaware of, which can result in pigment being pushed out as a result of the skin being hyper sensitive in its reaction to the procedure. In this case an additional complementary top-up session can be carried out but no more than 3 sessions can be done within 6 months. This is to avoid scarring which can occur if the area is overworked.
I will be using the following payment method:
Cash or Card In Person (Deposit Required)
Paypal or Paypal Credit
Pretty Face Finance
Cash or Card Online or Link
For clients using a monthly payment plan option with Pretty Face Finance, this is a third party and a credit check will be required as part of their application process. If this is declined, Earth & Beauty will not be able to offer you a payment plan option. Laybuy and Paypal Credit are also payment options integrated at checkout.
I understand that refunds are not offered and in the unlikely event that I am unhappy with my results I will contact Earth & Beauty to discuss a way forward.
I certify that I fully understand the process of the treatment and the consent required from me. I accept full responsibility for agreeing to the treatment, knowing what type of complications may arise as a result of, or during or following the procedures which is to be performed at my request according to this consent.
I confirm all above information has been understood, agreed to and that all procedure-related advice will be followed. All information I have provided is accurate and true to my knowledge.
I accept terms & conditions
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