Client Consent Form

This form is required to be completed BEFORE any service. Please read, initial, sign and submit this form PRIOR to your appointment. All fields with an asterick (*) are required.

Name

First Name

Last Name

Phone

(###)

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I understand a skin test of the pigment is offered upon request and the result is not viewed by a medical professional unless I make arrangements to have this done myself. A non-reactive skin test does not preclude an allergic reaction occurring at a future point in time

I have informed my permanent cosmetic technician of any existing health problems

I acknowledge that complications are always possible as a result of the permanent makeup procedure, particularly in the event that the post procedural instructions are not followed.

I acknowledge that hyper-pigmentation (darkening of the skin) or hypo pigmentation (the absence of color in the skin), or scarring is possibility as a result of my body’s reaction to the skin being broken during the procedure, I realize my body is unique and that my permanent technician cannot predict how my skin may react as a result of this procedure.

I acknowledge the receipt of written instructions advising me of the proper care of my procedure and I recognize the absolute necessity of following these instructions.

I acknowledge that the procedure will result in permanent change to my skin and no representations have been made to me as the ability to later change or remove the results

I understand that future laser treatments and other skin altering procedures, such as plastic surgery, implants and injections may alter and degrade my permanent makeup. I further understand that such changes are not the responsibility of my permanent makeup technician. I further I understand that such changes in my appearance may not be correctable through further permanent makeup procedures

I am aware that cosmetic tattooing is not an exact science, and I acknowledge that no guarantees have been made to me as a result of the procedures

I authorize my permanent makeup technician to obtain pre procedural and post procedural photos and to use such photographs for publication or teaching purposes, as she chooses.

I understand that tattoos may cause MRI(magnetic resonance imaging) artifacts and that there’s may be a warming or tingling sensation in the permanent cosmetic procedural area during the MRI due to the iron oxide properties of some pigments. It is understood that I should advise my physician that I do have permanent cosmetics (a tattoo) in the event of an MRI procedure is prescribed.

The fee for permanent makeup services has been explained to me and has been agreed upon. I understand the total fee for services rendered is due upon completion of the initial procedure and there will be separate fees for future modification of the design or major color changes.

Due to the fact that your approval is obtained prior to the final selection of color to be implanted and design application to be applied. I employ a no refund policy

For some skin types, permanent makeup may be a multi session procedure. In addition to your initial application you are entitled to a post evaluation appointment

It had been explained to me that immediately after the procedure is completed the color will appear darker than when the procedure is healed. It has also been explained to me that within a short period of time the healing process, the color will lighten to an ashy color that is softer then what was originally done on the first day, and at about 30 days is when the color will resurface.

All color fades – this is a fact which also applies to pigments/inks used to tattooing. After your procedure the pristine appearance of you tattoo is very dependent upon daily maintenance of avoiding sunlight (intentional tanning), avoiding strong chemicals being applied to the procedural area and applying sunblock daily. Color refreshers will be needed at some point in the future. The time frame cannot be predicted for every client is different.

I have read and understand the contents of each paragraph above. I have received no unrealistic warranties or guarantees with respect to the benefits to be realized from, or consequences of, the aforementioned procedures.

Your signature below represents consent for permanent cosmetic services and shall remain in effect during the entire time you remain my permanent cosmetic client.

I acknowledge by signing this consent form I have been given the full opportunity to ask any and all questions about the permanent makeup procedures from my permanent makeup technician.