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Consent To Application OF Permanent Cosmetics

To register, please take the time to fill out the information below.

First Name

Last Name

Phone

Birthday

I am over the age 18, am not under the influence of drugs or alcohol, am sound of mind and capable of making decisions for myself, am not pregnant or nursing, have no health conditions contraindicated to and desire to receive the indicated permanent cosmetic procedure. The general nature of cosmetic tattooing as well as the specific procedure to be performed has been explained to me.

I have thoroughly read and understand the webpage that I was instructed to read prior to my appointment, I asked any/all questions that I had relating to this document.

I understand that the taking of before and after photographs of the said procedure(s) are a condition of such procedure(s), and give my permission for them to be used in future marketing/advertising.

I have been informed of the nature, risks, and possible complications and consequences of permanent cosmetics skin pigmentation. I understand the permanent skin pigmentation procedure carries with it known and unknown complications and consequences associated with this type of cosmetic procedure, including but not limited to: infection, scarring, inconsistent color, and spreading, fanning, migrating or fading of pigments.

I understand that this procedure may involve pain and discomfort during and after the procedure despite the use of topical anesthetic preparations and swelling, redness or bruising may occur.

I fully understand that this is a tattoo process and therefore not an exact science, but an art, and 100% success or perfection cannot be guaranteed. I request the permanent skin pigmentation procedure(s), and accept the permanence of the procedure as well as the possible complications and consequences of the said procedure(s).

I agree that whether or not I am satisfied with the outcome of the procedure, refunds of any amount are not available.

I acknowledge that that it is not reasonably possible to determine whether or not I might have an allergic reaction to any of the pigments, topical preparations or tools used in the procedure. I agree to accept the risk that such a reaction is possible and release the technician from liability if I develop an allergic reaction.

I understand that the FDA has not has not yet approved tattoo inks, dyes or pigments and that health consequences of using these products are unknown at this time.

I understand that I will have the opportunity to approve the color and position of the permanent cosmetics to be applied, and I accept responsibility for the choice of the color, shape and position of my eyebrows, eyeliners, lip liner, lip extension and/or full lip color fill in. I accept responsibility for explaining my desires to the technician before the procedure.

I understand that human faces are naturally asymmetrical due to bone structure, muscle movement and skin laxity, and although my permanent cosmetics technician will make an effort to correct any asymmetry I have presented, a perfect symmetrical outcome is not implied or guaranteed.

I understand that the actual color of the pigment may be modified slightly due to the tone and color of my skin.

I understand that if I am requesting Hair Stroke or ‘Microblading’ Eyebrow styles of permanent cosmetics, that crisp, defined pigment is not guaranteed on all skin types. I understand that if I have combination, oily, very oily or aged skin with wrinkling that the individual pigment strokes may heal wider, blurred or even as a solid color. I have been informed of such potential outcome and given other options and agree to proceed.

I understand that correcting or touching up Permanent Cosmetics procedures that were previously performed by other technicians involves additional risks because of the existence of permanent pigments of unknown composition, brand, color, age, shape and other factors over which my technician has no control. I understand that additional appointments after the initial procedure and follow-up appointments may be required, and will be billed at the standard rates. I understand that my technician cannot predict the results in advance and cannot guarantee and has not represented that the results will be as I desire.

Your Signature

*All services provided are non-medical and non-invasive.*

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