Consent & Indemnity Form

HISTORY *

I have accurately provided all information requested, including relevant medical history and any possible contraindications.

ANAESTHETICS AND SUNSCREEN *

I have no known allergies to local anaesthetics or PABA (sunscreen) and have never suffered any adverse reaction to local anaesthetics prior to procedure. I therefore consent to the technician using topical anaesthetic to minimise discomfort during the procedure.

LASER PROCEDURES *

I have not had any other laser or IPL procedure within 21 days prior to this procedure.

PROCEDURE *

The nature and method of the proposed procedure has been explained to me by a Glowtique technician. I understand the usual risks inherent in the procedure and the possibility of complication during and following the procedure.

VARIABILITY OF RESULTS *

I understand that each case is individual and results may vary from person or person and between procedures. These results may be due to a number of variables such as: age; hormonal changes; condition/colour of skin/hair; sun exposure; and/or medications.

BROW PREPARATION *

To prepare for your procedure or to assist in creating the desired shape of brow, eyebrow hair may be removed by way of scissors, razor or tweezers.

POTENTIAL DISCOMFORT *

Adverse effects of this procedure have been explained to me. I understand that both during and after procedure I may experience some degree of discomfort. This may include but is not limited to common skin reactions such as inflammation (redness) and swelling.

POTENTIAL COMPLICATIONS *

I understand that although complications are very rare, sometimes an unexpected outcome may occur, and that prompt attention is necessary.

In the event of any unexpected outcome, I will immediately contact Glowtique. I will follow the technician's instructions and seek professional medical attention in the event of complications occurring.

INDEMNITY *

I acknowledge that the chosen procedure/s will only be carried out at my request.

I accept that there is a risk that the procedure area may suffer harm during, or as a result of, my requested procedure.

I acknowledge that if I consent to the procedure, I shall not be entitled to take action against the practitioner or Glowtique either at law or in equity in respect of this procedure.

AFTER CARE *

I acknowledge that I will receive a post procedure care brochure to take home. In order to maximise positive results I further agree to follow all post procedure care instructions, as I am directed.

REFUNDS *

I acknowledge that NO REFUND will be given on this procedure.

BLOOD DONATION *

I acknowledge that I am not able to donate blood for a period of six months, following any permanent makeup procedures.

PHOTOGRAPHS *

Photographs must be taken before and after each procedure to help us monitor the response to the procedure.

Occasionally we (Glowtique Studio or its agents) may use images for training; promotional; social media; and case study purposes.

CHOICE *

I confirm that during my consultation, I have been given the opportunity to make decisions on the shape, techniques and colour for my procedure and that the final decisions are my choice.

CONSENT *

I have carefully read and understood all points in this Consent and Indemnity Form and I agree to have this procedure performed on me.