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Microblading Consent Form

Please complete this form before your appointment. Your answers help us keep you safe and are only used for your service. Fields marked * are required.

Your information

Full name *

Date of birth *

Phone *

Email * Home address

Emergency contact name

Emergency contact phone

Health history

Check anything that applies to you. If you check a box, please add a few details in the box at the end of this section.

I am pregnant or breastfeeding Diabetes Hepatitis, HIV, or another bloodborne condition Herpes or cold sores Eczema, psoriasis, dermatitis, or broken/irritated skin near my brows History of keloid scarring I take blood thinners or regularly use aspirin, ibuprofen, fish oil, or vitamin E Accutane / isotretinoin in the last 12 months Botox or fillers in the last 4 weeks Chemical peel, laser treatment, or microneedling in the last 4 weeks Allergies to latex, lidocaine or topical anesthetics, pigments/inks, metals, or adhesives Autoimmune condition, heart condition, or pacemaker I have had permanent makeup on my brows before Details on anything you checked, plus any medications you take

Please read and agree

I understand microblading is a form of permanent makeup (tattooing): pigment is implanted into the skin with a manual hand tool, and the result is long-lasting but not completely permanent — color softens and changes over time. * I understand the risks, including pain, swelling, infection, allergic reaction, scarring, and pigment spreading or changing color. I have had the chance to ask questions. * I understand results vary from person to person, healed color and shape cannot be guaranteed, and a touch-up session is a normal part of the process. * Everything in this form is true. I will follow the aftercare instructions I am given, and I understand poor aftercare can affect my results and my health. * Before my appointment I will avoid alcohol and caffeine for 24 hours, and I will not take blood thinners (unless prescribed by my doctor). * I understand permanent makeup can interact with MRI scans, and I will tell medical staff I have permanent makeup before any MRI. * I confirm I am 18 years or older. * I understand the booking policy: the $100 consultation fee goes toward my deposit only if I book my microblading service the same day; otherwise it is non-refundable. A $100 non-refundable deposit is required to book, and 48 hours’ notice is needed to reschedule. *

Photos

Yes — Aaliyah may use my before/after photos for her portfolio and social media No — please don’t use my photos

Signature

Type your full name as your signature * I agree that typing my name counts as my signature on this form. *

Your form goes directly to Aaliyah’s Beauty & Brows and is used only for your appointment and your safety.