LYNN NANO NEEDLING CONSENT FORM

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Please fill out form prior to your appointment.
For all any question , please contact us.
lynn@lynnsalon.com
Call or text @ (669)-278-7220

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Date of appointment scheduled

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PRE-CARE INSTRUCTIONS

Please choose any condition listed below that apply to you

Asthma

Eczema/Psoriasis

Gonorrhea

HIV

Hepatitis

Heart Conditions

Syphilis

Herpes

Skin Conditions

Blood Thinner

Fainting/Dizziness

Hemophilia

Scarring/Keloid

Diabetes

Please check any of the following contraindications that pertain to you.

If you use any medications that might affect the healing of body art you desire to receive

If you have any allergies or have you ever experienced allergic reactions to any kinds of medications, foods or products

If you receive botox or fillers in the brow or forehead area

If you or have you ever suffered an allergic reaction to any local/topical anesthetics

If you are Pregnant/Breastfeeding

If you are under the age of 18. (Client's must be the age of 18+ to proceed with an appointment)

If you are diabetic, anemic or have any blood deficiencies

If you are currently taking any medication

If you have any history of cancer or you have any radiation or chemotherapy treatment

If you have any of the following hair removal methods in the past 6 weeks

NONE OF THESE ABOVE APPLY TO ME

Blood Deficiencies such as HIV or Hepatitis are suggested not to proceed with the procedure. Due to difficulties of the body being able to fight infections, it would be in your best interest not to move forward with a procedure. Brows Tattoo will cause numerous of injuries to the skin during ink application, so it will be a high risk of infection

Pregnant (Due to retention and safety reason, we do not suggest anyone that is pregnant to move forward with any semi permanent procedure.)
Breastfeeding (If breastfeeding, you must wait after you stopped breastfeeding and your first mensural cycle arrives)

DEPOSITS AND CANCELATIONS / COMMITMENT FEE OR RECHEDULING The payment will only be refundable if the cancelation is on our end or if services are cancelled with at lease 48 hours notice .If you cancel your appointment outside of the 24 hours window , you will forfeit $50 from your booked deposit .We offer a grace period of 15 minute only. Exceptions will not be made, as you are responsible for scheduling your time accordingly. All arrivals later than 15 minutes will result in a late fee of $40. If the time exceeds 30 minutes late results in a cancellation and an additional non-refundable commitment fee will be required to reschedule your appointment.

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