SALINE TATTOO REMOVAL & NON-REFUNDABLE DEPOSIT CONSENT Name * First Name Last Name DOB * MM DD YYYY Email * Date MM DD YYYY Phone * (###) ### #### What area on the body is the tattoo located * Describe the tattoo to be lightened * Which of the following best describes your skin type? (Please Check ONE) * 1. Always burns, never tans 2. Always burns, sometimes tans 3. Sometimes burns, always tans 4. Rarely burns, always tans 5. Brown, moderately pigmented skin 6. Black skin PLEASE READ AND AGREE BELOW * The nature and method of the proposed pigment (tattoo) lightening procedure has been explained to me including risks or possibility of complications during or following its performance. I understand there may be a certain amount of discomfort or pain associated with the procedure and that the other adverse side effects may include: minor and temporary bleeding, bruising, redness or other discoloration and swelling. Fever blisters may occur on the lips following lip procedures in individuals prone to this problem. Secondary infection in the area of the procedure may occur, however if properly cared for, this is rare. * I understand that several treatments may be needed in order to attempt to achieve my desired results. However, I have not received any guarantees to the quality of the outcome of the process. * I understand there are medical options available for pigment (tattoo) removal. I have decided to decline those methods. * I understand that the unwanted pigment may not be successfully lightened to the point that it can no longer be seen. Scarring, hyperpigmentation or hypopigmentation, or other damage to the skin may occur during this process and may be permanent. This is rare but it can happen. I will not hold my technician, the studio and/or the distributor/manufacturer of tattoo removal products used in this attempted pigment (tattoo) lightening or removal liable for any damages that may occur to my person. * I understand there will be no refunds if the desired lightening result is not achieved. * For skin types 5 and 6, I understand that I am at a higher risk for hyperpigmentation and hypopigmentation than other skin types. I agree with the risk involved. * I understand that lightning tattoo pigment is difficult, if even possible. As a result I will not hold my technician or the studio responsible for any resultant failure to lighten the unwanted pigment. * I agree to submit to before and after photographs, and give my permission to use such photographs for publication and/or teaching purposes. * I agree to follow all aftercare instructions provided by me by my technician. * I have been duly informed of the natures, risks, possible complications and consequences as listed above. I further understand that my technician is not a medical doctor. * I have received a consultation and I have been quoted a fee for this service. I understand that if additional sessions are needed I am responsible to purchase additional visits for an additional fee. The price has been explained to me and I agree to the fees. Fees for the additional session (s) cannot be determined until the results from this first session are complete and how much needs to be done the additional session (s) can be determined. * I have disclosed all that has been asked of me to the best of my ability and I understand all information listed above. I have had all my questions answered, and agree to all conditions and provisions of this document as evidenced by signature below. I accept the risks for having this procedure done therefore release my technician and the studio from any and all liability * Office Policies * I agree to BR Brows and Beauty's cancellation and etiquette policies. I understand that a $100.00 dollar Non Refundable deposit is required to secure my initial appointment. I understand that a 48-hour notice is required for all cancellations!!! If you Do Not Cancel within 48hrs to your scheduled appointment time, For ANY REASON a fee of $100.00 will be automatically charged to the card on file. It is REQUIRED that all Clients have a card on file (please provide card info below). If a client does not show for an appointment or does not give proper notice after the second time, the next appointment is REQUIRED to be paid in full. If a client comes in for a pre booked service and decides to decline getting said procedure done, you are required to still pay the Full Service Fee. Clients who do not confirm their appointments through our reminders or confirm through text and phone calls will be removed, and replaced with a client on the cancellation list and charged the cancelation fee. Additionally, children under the age of 18 are NOT permitted in the office. I understand that by violating office policies, BR Brows and Beauty has the right to refuse service or charge me, the client, a fee (stated above). I understand and accept the Office Policies. I consent and have answered all of the above to the best of my ability. I give my consent to make this my default Credit card for all digital and in-person payments. * Non-Refundable Deposit Consent: Please read and check the box below. The undersigned, hereby agree to pay BR Brows + Beauty the amount of $100.00 as a NON-REFUNDABLE DEPOSIT in order to book a TATTOO REMOVAL SERVICE. The undersigned, acknowledges, understands, and agrees that if he/she chooses to cancel said appointment at any point in time after making said deposit, THAT ALL DEPOSITS AND PAYMENTS MADE TO THAT POINT SHALL BE FORFEITED WITH NO REFUND OFFERED. The undersigned have been informed of this policy verbally, and consent to paying the $100.00 Non-Refundable deposit. The undersigned, acknowledges that there are no exceptions in which BR Brows + Beauty would refund said Non-Refundable deposit. The undersigned acknowledges, understands, and agrees that said deposit is NOT a credit, and that Deposits made are NOT transferable to other clients. By signing below, the undersigned, acknowledges, understands, and agrees to BR Brows + Beauty’s Non-Refundable Policy. I understand and accept BR Brows + Beauty's Non-Refundable Deposit Policy. * * * I AGREE AND UNDERSTAND THE ABOVE TERMS AND ASSUME ALL RESPONSIBILITY I give my consent to make this my default Credit card for all digital and in-person payments. * Expiration Date: * Security Code (CVV) REQIRED * BILLING ZIP CODE * Digital Signature * Thank you!