PLEASE READ CAREFULLY - HAVE YOU HAD OR DO YOU CURRENTLY HAVE ANY OF THE FOLLOWING? PLEASE CHECK THE BOX.
* IF YOU SUFFER FROM ANY OF THE ABOVE, IT IS IMPORTANT THAT YOU NOTIFY YOUR ARTIST SO THAT THEY CAN TAKE THE NECESSARY PRECAUTION TO ENSURE YOU RECEIVE THE BEST TREATMENT TO AVOID ANY RISKS TO YOUR HEALTH.
PLEASE READ CAREFULLY AND AGREE / SIGN WHERE INDICATED.
ENSURE ALL POINTS BELOW HAVE BEEN DISCUSSED WITH YOUR ARTIST. YOU ARE SIGNING TO STATE THAT YOU UNDERSTAND AND ACCEPT THESE TERMS & CONDITIONS.
I ACKNOWLEDGE THAT ANY INFORMATION CONTRIBUTED BY ME IS TRUE, TO THE BEST OF MY KNOWLEDGE AND THAT THE PRESENT CONDITION OF THE AREA THAT HAS BEEN TREATED OR WILL BE TREATED IS STATED ON THIS RECORD. I FULLY UNDERSTAND THAT BROWHOUSE TECHNICIANS PROVIDE BEAUTY SERVICES; THERE IS NO MEDICAL TREATMENT INVOLVED. PLASMA PEN AND/OR JET PLASMA TREATMENT IS AN ART - NOT AN EXACT SCIENCE - AND CANNOT GUARANTEE AN EXACT SHRINKAGE RESULT DUE TO SKIN ELASTICITY AND INDIVIDUAL, WHICH INCLUDES THE CLIENT'S HEALTH, GENETICS, LIFESTYLE FACTORS, AND FOLLOWING PROPER AFTERCARE.
I UNDERSTAND THAT JET PLASMA REQUIRES SESSIONS, A MINIMUM OF 3 SUGGESTED FOR BEST RESULTS, AND THAT I MAY BE REQUIRED TO RETURN FOR ADDITIONAL TREATMENTS BEFORE THE OVERALL PROCEDURE IS DEEMED COMPLETE. THE PAYMENT FOR ANY ADDITIONAL WORK (IF APPLICABLE) WILL BE AGREED UPON PRIOR TO THE TREATMENT COMMENCING. DEPENDING UPON THE AREA OF TREATMENT, ADDITIONAL TREATMENTS CANNOT BE PERFORMED UNTIL 6-8 WEEKS AFTER 8 SESSIONS SAME AREA TO ALLOW SUFFICIENT HEALING TIME.
I REALIZE THAT WITH ANY BEAUTY SERVICE, THERE MAY BE CERTAIN RISKS THAT MUST BE UNDERSTOOD. I WILL BE FULLY RESPONSIBLE FOR ANY AND ALL RESULTS WHICH MAY ARISE FROM THESE BEAUTY SERVICES. I DO HEREBY AGREE TO HOLD BROWHOUSE TECHNICIANS, THEIR AFFILIATES, AND EMPLOYEES/STUDENTS FREE FROM ANY AND ALL CLAIMS OR SUITS FOR DAMAGE, FOR INJURIES, OR COMPLICATIONS RESULTING FROM ANY BEAUTY SERVICES PROVIDED BY BROWHOUSE AND BROWHOUSE ARTISTS . I UNDERSTAND THAT ANY SPOT REMOVALS / SKIN REVISION WORK PERFORMED MAY RESULT IN THE LOSS OR GAIN OF NATURAL SKIN PIGMENT.
THE SKIN TYPE OF EVERY CLIENT IS DIFFERENT, AND ALTHOUGH JET PLASMA IS SAFE FOR ALL SKIN TYPES, IT IS IMPORTANT YOU FOLLOW OUR AFTERCARE INSTRUCTIONS. ADDITIONAL SESSIONS MAY BE ADVISED AFTER THE HEALING PROCESS IS COMPLETE.
I UNDERSTAND THAT TAKING BEFORE AND AFTER PHOTOGRAPHS OF THE SAID PROCEDURES IS A REQUIREMENT OF SUCH PROCEDURE. I GRANT PERMISSION FOR THE USE OF THE PHOTOGRAPHS OR ELECTRONIC MEDIA IMAGES AS IDENTIFIED IN ANY PRESENTATION OF ALL KINDS.
I TRUTHFULLY REPRESENTED TO THE TECHNICIAN THAT I AM 18 YEARS OF AGE OR OLDER. I AM NOT UNDER THE INFLUENCE OF ANY DRUGS OR ALCOHOL. TO MY KNOWLEDGE, I DO NOT HAVE ANY PHYSICAL, MENTAL, OR MEDICAL IMPAIRMENT OR DISABILITY THAT MIGHT AFFECT MY WELL-BEING AS A DIRECT OR INDIRECT RESULT OF MY DECISION TO HAVE A TATTOO AT THIS TIME.
I UNDERSTAND THAT TAKING BEFORE AND AFTER PHOTOGRAPHS OF THE SAID PROCEDURES IS A REQUIREMENT OF SUCH PROCEDURE. I GRANT PERMISSION FOR THE USE OF THE PHOTOGRAPHS OR ELECTRONIC MEDIA IMAGES AS IDENTIFIED IN ANY PRESENTATION OF ALL KINDS.
I UNDERSTAND THE IMPORTANCE OF MY ACCURATE AND COMPLETE MEDICAL HISTORY. I UNDERSTAND THAT WITH HOLDING ANY MEDICAL INFORMATION MAY BE DETRIMENTAL TO MY HEALTH AND SAFETY DURING AND AFTER THE PROCEDURE. I UNDERSTAND THAT IF THERE IS ANY CHANGE IN MY MEDICAL HISTORY, IT IS MY RESPONSIBILITY TO INFORM THE TECHNICIAN.
I AM AWARE THAT ANY SKIN-ALTERING PROCEDURES, SUCH AS LASER TREATMENTS, PLASTIC SURGERY, IMPLANTS, INJECTABLES, AND WEIGHT GAIN OR LOSS, MAY ALTER THE TREATMENT LOOK.
PLEASE BE ADVISED THAT PLASMA PEN PROCEDURES ARE A NON-INVASIVE ALTERNATIVE TO PLASTIC SURGERY. PLASMA PEN DOES NOT REPLACE NOR CLAIM TO REPLACE PLASTIC SURGERY.
CONSENT AND DECLARATION OF BEING INFORMED ABOUT THE PLASMA PEN TREATMENT PROCESS.
BY SIGNING THIS CONTRACT, BOTH THE SERVICE PROVIDER AND THE CLIENT (HEREINAFTER PARTIES) ACKNOWLEDGE THAT THEY ARE WELL AWARE OF THE PLASMA PEN TREATMENT PROCESS AND ITS STAGES OF HEALING AND ACKNOWLEDGE THAT FULL HEALING IS 8-12 WEEKS. PARTIES ALSO ACKNOWLEDGE ALL THE POSSIBLE DANGERS RELATED TO THAT PROCESS AS A WHOLE AND TO ITS DIFFERENT STAGES. THE SERVICE PROVIDER CONFIRMS THAT SHE/HE HAS RECEIVED SUFFICIENT TRAINING AND CERTIFICATION, MAKING IT LEGAL TO PERFORM THE PLASMA PEN PROCEDURE. THE CLIENT CONFIRMS THAT SHE/HE HAS COMPLETELY UNDERSTOOD WHICH TECHNOLOGY IS BEING USED WHEN IT COMES TO PLASMA PEN, TAKING INTO ACCOUNT THAT THE CLIENT HAS MADE AN INFORMED DECISION TO GO FORWARD WITH THE PROCEDURE AND HAVE THE PLASMA PEN TREATMENT DONE.
SATISFACTION WITH THE RESULTS
HEREBY, THE CLIENT ACKNOWLEDGES THAT HE/SHE IS WELL AWARE OF THE RANGE OF DIFFERENT OUTCOMES THAT THE PROCESS OF PLASMA PEN PROCEDURES CAN RESULT IN. THE CLIENT ALSO ACKNOWLEDGES THAT WE CANNOT AND WILL NOT GUARANTEE THAT THE CLIENT WILL BE SATISFIED WITH THE END RESULTS OF PLASMA PEN TREATMENT. ‘LIKING” THE CHANGE IN BODY AND/OR FACIAL WRINKLE REMOVAL OR NOT LIKING THE OUTCOME OCCURRED IS PURELY AN EMOTIONAL EVALUATION, AND THERE ARE OR CANNOT BE ANY UNIVERSAL STANDARDS THAT ENABLE TO SET A LEVEL OF THE RESULT BEING SATISFACTORY OR NOT SATISFACTORY. ACCORDING TO THE STANDARDS OF PLASMA PEN TREATMENT, THE CLIENT ACKNOWLEDGES HAVING NO FURTHER COMPLAINTS REGARDING THE LIKEABILITY OF THE END RESULT THAT PRO PLASMA ESTHETIC WOULD HAVE TO REACT.
THE CRITERIA THE SERVICE PROVIDER HAS TO MEET IN ORDER TO BE ABLE TO CLAIM THAT THE PROCESS HAS BEEN CARRIED OUT THE CORRECT WAY.
1. THE CLIENT HAS BEEN INFORMED ABOUT THE STAGES OF THE PROCEDURE AND DESCRIBED THE PRINCIPLE DIFFERENCE BETWEEN NECESSARY STEPS TAKEN PRIOR TO THE PROCEDURE, DURING THE PROCEDURE, AND FULL AFTERCARE INSTRUCTION.
2. BROWHOUSE ARTIST HAS DESCRIBED EXPECTATIONS AND ANY CHARGE ON TREATMENT OF FACIAL SKIN AND/OR BODY, AND THE CLIENT AGREES TO AREAS BEING TREATED.
3. BROWHOUSE ARTIST FOLLOWS ALL REQUIREMENTS FOR HYGIENE FOR THAT PROCEDURE.
4. BROWHOUSE ARTIST HAS DESCRIBED TO THE CLIENT ALL THE POSSIBLE COMPLICATIONS OF THE PROCEDURE, AND THE CLIENT HAS HAD AN OPPORTUNITY TO ASK QUESTIONS ABOUT COMPLICATIONS AND UNDERSTANDS BROWHOUSE ARTIST IS NOT LIABLE FOR ANY ADVERSE EFFECT NOT SATISFACTORY.
THE FOLLOWING PERTAINS TO SPOT PLASMA TREATMENT;
PLEASE NOTE: LARGER BODY AREAS TREATED WITH PLASMA PEN MAY REQUIRE ADDITIONAL DOWNTIME AND HEALING. SINCE EVERY CLIENT IS UNIQUE AND HEALS DIFFERENTLY, WE UNFORTUNATELY CANNOT TELL YOU EXACTLY HOW LONG YOUR DOTS MAY TAKE TO SHED. DOWNTIME MAY VARY FROM PERSON TO PERSON, AS WELL AS PAIN LEVEL DURING HEALING. THE PAIN TYPICALLY SUBSIDES WITHIN THE WEEK. KEEP IN MIND THAT THE LARGER THE AREAS BEING TREATED, THE HARDER THE BODY HAS TO WORK TO HEAL. THE CLIENT'S AGE, GENETICS, HEALTH, AND LIFESTYLE FACTORS ALL PLAY A ROLE IN THE HEALING PROCESS.
SCHEDULING POLICIES
WE REQUIRE 72 BUSINESS HOURS NOTICE FOR CANCELING APPOINTMENTS. WE ASK THIS SO WE MAY OPEN UP YOUR TIME SLOT TO ANOTHER CLIENT. CANCELLATIONS MADE LESS THAN 72 BUSINESS HOURS MAY RESULT IN A CHARGE FOR THE SCHEDULED APPOINTMENT. NO-SHOW APPOINTMENTS WILL BE CHARGED $150. YOUR SCHEDULED APPOINTMENT IS BOOKED FOR YOU AND ONLY YOU, AND OUR ARTISTS CAN NOT FILL NO-SHOW APPOINTMENTS, SO WE ASK OUR CLIENTS TO HAVE CONSIDERATION FOR THEIR ARTISTS. WHEN SCHEDULING YOUR APPOINTMENT, WE REQUIRE A CREDIT CARD NUMBER TO HOLD YOUR APPOINTMENT.
REQUIRED CONFIRMATIONS
APPOINTMENTS MUST BE CONFIRMED, AND WE'VE MADE IT SUPER EASY TO DO SO! EACH CLIENT RECEIVES A CONFIRMATION EMAIL 72 HOURS BEFORE THEIR SCHEDULED VISIT. THIS EMAIL HAS A BIG GREEN BUTTON TO CLICK THAT SAYS "CONFIRM. " TEXTS ARE ALSO SENT IF YOU ARE SIGNED UP FOR THEM; SIMPLY REPLY "YES. " IF THESE GO UNCONFIRMED, WE WILL CALL YOU FOR A CONFIRMATION DAY BEFORE.
CONSENT FORM CONFIRMATION
I HAVE COMPLETED THIS FORM TO THE BEST OF MY KNOWLEDGE AND AGREE THAT THE INFORMATION I HAVE PROVIDED IS TRUE AND ACCURATE. BROWHOUSE IS NOT RESPONSIBLE FOR ANY SIDE EFFECTS CAUSED BY INACCURATE INFORMATION I HAVE DISCLOSED ON THIS FORM. I UNDERSTAND THAT WHILE EVERY PRECAUTION IS TAKEN, ADVERSE REACTIONS ARE A POSSIBILITY WHEN RECEIVING MY SERVICE, INCLUDING SKIN IRRITATION, LIFTING ETC. I UNDERSTAND ANY CONTRAINDICATION BOXES I CHECKED ON THIS FORM CAN INCREASE MY CHANCES OF ADVERSE REACTIONS TO SERVICES. I UNDERSTAND ALL HEALTH HISTORY INFORMATION I PROVIDED IS CONFIDENTIAL AND CAN NOT BE SHARED WITH ANYONE OTHER THAN BROWHOUSE AND ITS EMPLOYEES. I GIVE BROWHOUSE AND ITS ARTISTS PERMISSION TO PERFORM THE SERVICES I REQUEST.
