The Bomb Aesthetics
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Hair Growth Consent Form
Personal Information
Name
First
Last
Phone number
Email address
Date of Birth
YYYY slash MM slash DD
Treatment Information
Type of treatment
Microneedling
High Frequency
Date of treatment
DD slash MM slash YYYY
Technicians name
Medical Information
Do you have any known allergies?
Yes
No
List of allergies
Are you currently taking any medications?
Yes
No
List of medication
Acknowledgments
I understand that hair growth results from treatment may vary based on individual factors and that there is no guaranteed outcome.
I acknowledge the possibility of allergic reactions to products used and absolve The Bomb Aesthetics and its technicians of liability should an allergic reaction occur. If I suspect I might be allergic, I have the option to request a patch test beforehand.
I am aware that post-treatment care is crucial for optimal results and agree to follow all provided aftercare instructions.
I understand the potential risks associated with microneedling and high frequency treatments, including but not limited to redness, swelling, or irritation.
I recognize that additional sessions may be necessary to achieve desired results and will incur extra charges.
I acknowledge that The Bomb Aesthetics does not offer refunds for the treatment under any circumstances.
I release The Bomb Aesthetics and its technicians from responsibility for any costs related to medical treatment required as a result of the procedure.
Consent
I have read and understood the information above. By signing below, I consent to the eyebrow extensions treatment and release The Bomb Aesthetics from any liability related to the procedure.
Clients Signature
Date
DD slash MM slash YYYY
Technicians signature
Date
DD slash MM slash YYYY
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