Aura Consent Forms

Personal / Contact Details

Name

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Date of Birth (dd/mm/yyyy)

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Email Address

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Phone Number

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Postcode

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Address

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Therapist

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Patch Test All of our products undergo extensive testing in line with industry standards and comply with all applicable requirements to ensure that they are safe. However a person's reaction to any product is personal to them and products of any kind can cause allergy or other reactions.
We strongly recommend that all of our customers participate in a skin sensitivity test at least 48 hours prior to the full application of any product, to reduce the risk of an adverse reaction, even if previously used. However, you are responsible for your own safety and it is your decision as to whether you wish to participate in a test or not. Please tick the box applicable to you below, then sign and date this Consultation Form to confirm your understanding of this.
I have undergone an allergy/skin sensitivity test. I do, however, acknowledge that applying any product to the skin or hair is never entirely without risk.

Patch Test Date (dd/mm/yyyy)

Medical/Lifestyle History

Consent Form

I understand that semi-permanent makeup is a process that may need more than one application to achieve the desired results.

I understand that there may be swelling and possible scabbing of the area treated for up to 7 days after the treatment.

There may also be a slight change of the colour that has been implanted into the skin due to changes in the level of the skin. It is common for lightening of the treatment area of up to 30%.

I acknowledge that no guarantee has been made concerning the results of this treatment and no refund will be issued if I am not happy with the result.

I have read the above and have had the procedure fully explained to me. I have also been able to ask any questions concerning the procedure.

A have read the consent form and fully understand that I will not be able to take any legal action against AURA or hold them responsible for any adverse reactions with my procedure.

I am having the treatment at my own risk and accept full responsibility for any complications that may arise during or following my procedure.

I have been given a post-treatment leaflet.

Consent Form: Disclaimer

I understand a patch test is required before I have the above treatment due to a possible reaction to the product or glue. However, I am prepared to take full responsibility with this disclaimer and will not pursue any action against the therapist or salon should there be any reaction what so ever. No refunds will be given.

Please accept Disclaimer.

Ultrasensitive Skin	Yes No	History of Keloid Scarring	Yes No
Active Bacterial or Viral Infection	Yes No	Blood Clots	Yes No
Pregnancy	Yes No	HIV / AIDS	Yes No
Lupus	Yes No	Taking Antibiotics	Yes No
Hepatitis	Yes No	High/Low Blood Pressure	Yes No
Surgery in last 6 months	Yes No	Taking Blood Thinners	Yes No
Telangiectasia (Thread Veins)	Yes No	Laser Skin Resurfacing	Yes No
Hepatitis B/C	Yes No	Recent Scarring	Yes No
Tendency for Hyperpigmentation	Yes No	Skin Allergies	Yes No
History of Keloid Scarring	Yes No	Haemophilia	Yes No
Cancer	Yes No	Scars that turn White / Brown	Yes No
Latex Allergy	Yes No	Herpes Simplex Infection	Yes No
Rosacea and Blood Clotting Problems (ie Poor wound healing)	Yes No	Scars less than 6 months old	Yes No
Diabetes	Yes No	Hormone Creams	Yes No
Anticoagulants (eg Warfarın)	Yes No	Other Photosensitive Medications	Yes No

Micropigmentation (Eyebrows / Eyeliner / Lips)

Personal / Contact Details

Medical/Lifestyle History