New Client Consultation and Consent Form

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Do you have any of the following conditions?



Are you currently using any products that contain the following ingredients?




Although every precaution will be made to ensure your safety and well-being before, during and after any treatment performed, please be aware of the possible risks for different treatments below. 


I understand that lash/brows tinting/lash lift/lash extension has some inherent risk of irritation to the orbital eye area, including the eye itself, and could result in stinging or burning, blurry vision and potentially blindness should any solution enter into the eye.


I understand that if the tinting/lifting agent or glue accidentally comes into contact with my eye, my eye will be flushed with water and medical attention may be required.


I understand as part of the procedures eye irritation, eye pain, eye itching, discomfort and in rare cases eye infection may occur.


I understand that some irritation, itching or burning may occur to the skin which comes in contact with the treatment agents.


I understand that there may be some residual dark staining left on the skin following the tinting process of either my lashes, brows or both. This will fade and go away within a short time.


I understand that the patch test given does not guarantee that an allergic reaction will not occur.


I understand that, while every attempt will be made to provide me with my chosen colour, everyone's hair absorbs colour differently and my final results may not be the colour I initially wanted.


I understand that waxing does have certain side effects such as skin removal, redness, bruising, swelling, tenderness, etc.


I understand that Dermalogica Pro Power Peel is designed to resurface the skin. You may experience temporary burning, itching, or stinging. It is important that you strictly adhere to the home care products and regimen that your professional skin therapist has recommended. It is possible to have a poor reaction or less-than-expected improvement of the skin. No guarantee is made or implied as to the precise results, peeling times or discomfort.


If I have any concerns, I will address these with my skin care therapist.


I give permission to my therapist to perform the treatment/s we have discussed, and will hold her harmless from any liability that may result from this treatment.


I have accurately answered the questions above, including all known allergies, prescription drugs, or products I am currently ingesting or using topically.


I understand my aesthetician will take every precaution to minimize or eliminate negative reactions as much as possible.


In the event I may have additional questions or concerns regarding my treatment, I will consult the aesthetician immediately.


I certify that I have read, and fully understand, the above paragraphs and that I have had sufficient opportunity for discussion to have any questions answered. I understand the procedure and accept the risks.


I do not hold the Marija Ivanova responsible for any of my conditions that were present, but not disclosed at the time of this skin care procedure, which may be affected by the treatment performed today.


Your full participation during and after the treatment will determine the outcome.


I give my permission to the Marija Jefremova-Ivanova to collect, handle and store my personal data for treatment and appointment purposes in accordance with the GDPR guidelines, effective 25th May 2018

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