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Forms
Brow Lamination Consent Form
Dermaplaning Consent Form
Eyelash Extensions Consent Form
Facial Consent Form
Lash Lift and Lash Tint Consent Form
Tattoo Forms
Waxing Consent Form
402 669 7094
By Appointment Only
4935 S 136th St, Omaha, NE, 68137
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Step
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CLIENT CONSENT & LIABILITY FORM
I
*
acknowledge that I have read and fully understand this consent and liability form.
I agree to comply with all instructions given by the tattoo artist regarding the care of the tattoo.
I understand and acknowledge that: The process of tattooing involves piercing the skin with a needle and depositing ink into the skin. This process may cause pain, discomfort, swelling, and bleeding.
There is a possibility of an allergic reaction to the ink, and I have informed the tattoo artist of any known allergies or medical conditions that may affect the tattoo process.
The tattoo artist has explained the risks of infection associated with the tattoo process and has provided instructions for proper aftercare.
I understand not following before and aftercare instructions can effect my tattoo.
The tattoo artist has disclosed that the tattoo may not be removed completely, and that any attempt to do so may cause scarring, skin discoloration, or other complications.
The tattoo artist has disclosed that the final result of the tattoo may vary from the initial design due to factors such as skin texture, healing, and the skill of the tattoo artist.
I hereby release the tattoo artist from any and all liability, including but not limited to: injury, infection, allergic reaction, or damage to personal property that may arise as a result of the tattoo process.
I understand that the tattoo artist is not responsible for any medical expenses or other costs incurred as a result of complications arising from the tattoo process.
I understand payment is due in full at the time of the appointment.
I understand there may be need for touch ups and I will pay the amount due for any touch ups.
I certify that I am 18 years of age or older and have provided a valid form of identification.
I acknowledge that I have read and understand this client consent and liability form in its entirety, and I agree to its terms.
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CLIENT INTAKE FORM
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Name
*
Date
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Date of Birth
Age
Gender
Female
Male
NB
Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
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Phone
United States
+1
United Kingdom
+44
Afghanistan (افغانستان)
+93
Albania (Shqipëri)
+355
Algeria (الجزائر)
+213
American Samoa
+1
Andorra
+376
Angola
+244
Anguilla
+1
Antigua and Barbuda
+1
Argentina
+54
Armenia (Հայաստան)
+374
Aruba
+297
Ascension Island
+247
Australia
+61
Austria (Österreich)
+43
Azerbaijan (Azərbaycan)
+994
Bahamas
+1
Bahrain (البحرين)
+973
Bangladesh (বাংলাদেশ)
+880
Barbados
+1
Belarus (Беларусь)
+375
Belgium (België)
+32
Belize
+501
Benin (Bénin)
+229
Bermuda
+1
Bhutan (འབྲུག)
+975
Bolivia
+591
Bosnia and Herzegovina (Босна и Херцеговина)
+387
Botswana
+267
Brazil (Brasil)
+55
British Indian Ocean Territory
+246
British Virgin Islands
+1
Brunei
+673
Bulgaria (България)
+359
Burkina Faso
+226
Burundi (Uburundi)
+257
Cambodia (កម្ពុជា)
+855
Cameroon (Cameroun)
+237
Canada
+1
Cape Verde (Kabu Verdi)
+238
Caribbean Netherlands
+599
Cayman Islands
+1
Central African Republic (République centrafricaine)
+236
Chad (Tchad)
+235
Chile
+56
China (中国)
+86
Christmas Island
+61
Cocos (Keeling) Islands
+61
Colombia
+57
Comoros (جزر القمر)
+269
Congo (DRC) (Jamhuri ya Kidemokrasia ya Kongo)
+243
Congo (Republic) (Congo-Brazzaville)
+242
Cook Islands
+682
Costa Rica
+506
Côte d’Ivoire
+225
Croatia (Hrvatska)
+385
Cuba
+53
Curaçao
+599
Cyprus (Κύπρος)
+357
Czech Republic (Česká republika)
+420
Denmark (Danmark)
+45
Djibouti
+253
Dominica
+1
Dominican Republic (República Dominicana)
+1
Ecuador
+593
Egypt (مصر)
+20
El Salvador
+503
Equatorial Guinea (Guinea Ecuatorial)
+240
Eritrea
+291
Estonia (Eesti)
+372
Eswatini
+268
Ethiopia
+251
Falkland Islands (Islas Malvinas)
+500
Faroe Islands (Føroyar)
+298
Fiji
+679
Finland (Suomi)
+358
France
+33
French Guiana (Guyane française)
+594
French Polynesia (Polynésie française)
+689
Gabon
+241
Gambia
+220
Georgia (საქართველო)
+995
Germany (Deutschland)
+49
Ghana (Gaana)
+233
Gibraltar
+350
Greece (Ελλάδα)
+30
Greenland (Kalaallit Nunaat)
+299
Grenada
+1
Guadeloupe
+590
Guam
+1
Guatemala
+502
Guernsey
+44
Guinea (Guinée)
+224
Guinea-Bissau (Guiné Bissau)
+245
Guyana
+592
Haiti
+509
Honduras
+504
Hong Kong (香港)
+852
Hungary (Magyarország)
+36
Iceland (Ísland)
+354
India (भारत)
+91
Indonesia
+62
Iran (ایران)
+98
Iraq (العراق)
+964
Ireland
+353
Isle of Man
+44
Israel (ישראל)
+972
Italy (Italia)
+39
Jamaica
+1
Japan (日本)
+81
Jersey
+44
Jordan (الأردن)
+962
Kazakhstan (Казахстан)
+7
Kenya
+254
Kiribati
+686
Kosovo
+383
Kuwait (الكويت)
+965
Kyrgyzstan (Кыргызстан)
+996
Laos (ລາວ)
+856
Latvia (Latvija)
+371
Lebanon (لبنان)
+961
Lesotho
+266
Liberia
+231
Libya (ليبيا)
+218
Liechtenstein
+423
Lithuania (Lietuva)
+370
Luxembourg
+352
Macau (澳門)
+853
Madagascar (Madagasikara)
+261
Malawi
+265
Malaysia
+60
Maldives
+960
Mali
+223
Malta
+356
Marshall Islands
+692
Martinique
+596
Mauritania (موريتانيا)
+222
Mauritius (Moris)
+230
Mayotte
+262
Mexico (México)
+52
Micronesia
+691
Moldova (Republica Moldova)
+373
Monaco
+377
Mongolia (Монгол)
+976
Montenegro (Crna Gora)
+382
Montserrat
+1
Morocco (المغرب)
+212
Mozambique (Moçambique)
+258
Myanmar (Burma) (မြန်မာ)
+95
Namibia (Namibië)
+264
Nauru
+674
Nepal (नेपाल)
+977
Netherlands (Nederland)
+31
New Caledonia (Nouvelle-Calédonie)
+687
New Zealand
+64
Nicaragua
+505
Niger (Nijar)
+227
Nigeria
+234
Niue
+683
Norfolk Island
+672
North Korea (조선 민주주의 인민 공화국)
+850
North Macedonia (Северна Македонија)
+389
Northern Mariana Islands
+1
Norway (Norge)
+47
Oman (عُمان)
+968
Pakistan (پاکستان)
+92
Palau
+680
Palestine (فلسطين)
+970
Panama (Panamá)
+507
Papua New Guinea
+675
Paraguay
+595
Peru (Perú)
+51
Philippines
+63
Poland (Polska)
+48
Portugal
+351
Puerto Rico
+1
Qatar (قطر)
+974
Réunion (La Réunion)
+262
Romania (România)
+40
Russia (Россия)
+7
Rwanda
+250
Saint Barthélemy
+590
Saint Helena
+290
Saint Kitts and Nevis
+1
Saint Lucia
+1
Saint Martin (Saint-Martin (partie française))
+590
Saint Pierre and Miquelon (Saint-Pierre-et-Miquelon)
+508
Saint Vincent and the Grenadines
+1
Samoa
+685
San Marino
+378
São Tomé and Príncipe (São Tomé e Príncipe)
+239
Saudi Arabia (المملكة العربية السعودية)
+966
Senegal (Sénégal)
+221
Serbia (Србија)
+381
Seychelles
+248
Sierra Leone
+232
Singapore
+65
Sint Maarten
+1
Slovakia (Slovensko)
+421
Slovenia (Slovenija)
+386
Solomon Islands
+677
Somalia (Soomaaliya)
+252
South Africa
+27
South Korea (대한민국)
+82
South Sudan (جنوب السودان)
+211
Spain (España)
+34
Sri Lanka (ශ්රී ලංකාව)
+94
Sudan (السودان)
+249
Suriname
+597
Svalbard and Jan Mayen
+47
Sweden (Sverige)
+46
Switzerland (Schweiz)
+41
Syria (سوريا)
+963
Taiwan (台灣)
+886
Tajikistan
+992
Tanzania
+255
Thailand (ไทย)
+66
Timor-Leste
+670
Togo
+228
Tokelau
+690
Tonga
+676
Trinidad and Tobago
+1
Tunisia (تونس)
+216
Turkey (Türkiye)
+90
Turkmenistan
+993
Turks and Caicos Islands
+1
Tuvalu
+688
U.S. Virgin Islands
+1
Uganda
+256
Ukraine (Україна)
+380
United Arab Emirates (الإمارات العربية المتحدة)
+971
United Kingdom
+44
United States
+1
Uruguay
+598
Uzbekistan (Oʻzbekiston)
+998
Vanuatu
+678
Vatican City (Città del Vaticano)
+39
Venezuela
+58
Vietnam (Việt Nam)
+84
Wallis and Futuna (Wallis-et-Futuna)
+681
Western Sahara (الصحراء الغربية)
+212
Yemen (اليمن)
+967
Zambia
+260
Zimbabwe
+263
Åland Islands
+358
Email
*
Medical History
Please check any of the following medical conditions that apply to you:
Diabetes
High Blood Pressure
Low Blood Pressure
Heart Disease
Hemophilia or other Bleeding Disorder
Please check any of the following medical conditions that apply to you:
Hepatitis A, B, or C
HIV/AIDS
Skin Conditions (eczema, psoriasis, etc.)
Keloid Scarring
If you checked any of the above, please give details:
Any other conditions:
List any medications you take regularly, including vitamins, herbal supplements aspirin:
Have you had surgery in the past year?
Yes
No
If yes, please specify:
Do you have any allergies?
Yes
No
If yes, please specify:
Have you ever had a reaction to a tattoo or piercing?
Yes
No
If yes, please specify:
Tattoo Information
What is the tattoo you would like to get?
Where on your body would you like to get the tattoo?
How big do you want the tattoo to be?
Next
CLIENT INTAKE FORM (cont.)
Have you had tattoos before?
Yes
No
If yes, how many tattoos do you have?
Where are your tattoos located?
How did your previous tattoos heal?
By signing below, I acknowledge that I have read and understand the information on this form, and that all the information I have provided is accurate to the best of my knowledge.
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Notes:
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PHOTO AND VIDEO RELEASE FORM
I
*
hereby grant and authorize Adore LLC the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any pictures, videos, and /or audio taken of me to be used in and/or for any lawful promotional materials including, but not limited to, newsletters, flyers, posters, brochures, advertisements, press kits, websites, social media sites, and other print and digital communications, without payment or any other consideration.
This authorization shall continue indefinitely and extends to all languages, media, formats, and markets now known or later discovered.
I waive any rights to royalties or other compensation arising or related to the use of the photograph or recording.
I understand and agree that these materials shall become the property of Adore LLC and will not be returned.
And causes of action which I, my heirs, representatives, executors, administrators, or any I hereby hold harmless and release Adore LLC other persons may make while acting on my behalf or behalf of my estate.
By signing below, I hereby acknowledge that I have completely read and fully understand the above release agreement.
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APPOINTMENT CANCELLATION POLICY
Our goal is to provide quality care in a timely manner. In order to do so, we have had to implement an appointment/cancellation policy.
Appointments are in high demand, and your early cancellation will give another person the opportunity to have access to timely care. This policy enables us to better utilize available appointments for our clients.
I understand an active credit is due when booking my appointment and will be charged if I do not follow cancel and reschedule policies.
I understand there is no refund of any kind for any reason.
Time has been specifically reserved for your appointment, procedure, or treatment. I understand that Adore requires a 48hr notice of cancel or reschedule. I understand if I do not cancel or reschedule before 48hrs I will be charged full price of the service not including any discounts or specials to the card I placed on file to hold my appointment.
If you arrive more than 15 minutes late for your appointment it is considered a no-show and you will be charged the cancellation fee.
I have read and fully understand the above Appointment Cancellation Policy and agree to be bound by its terms. I agree to pay the cancellation fee in the event of a missed appointment.
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