CONSENT TO APPLICATION OF PERMANENT MAKEUP/MICROBLADING PROCEDURE

Please take a moment to complete our consent form. By submitting the form below you agree to knowingly and willingly consenting to have Permanent Makeup or Microblading service.

Please fill this form out on the date of your appointment. Thank you.

SIGNATURE BELOW I am over the age of 18, am not under the influence of drugs or alcohol, am not pregnant or nursing, and desire to recieve 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.

SIGNATURE BELOW I cerify and consent to be the model for a student's training benefit and understad that I will be recieving my service from a student in training, not yet certified, and that the student will be under the watchful supervision of the Master Artist.

Procedure(s):

Skin Type:

PLEASE READ AND INITIAL ALL STATEMENTS BELOW:

I have been informed of the nature, risks, and possible complications and consequences of permanent 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, or fading of pigments. Corneal abrasions are a rare side effect, especially if I rub or scratch my eyes or apply contacts too soon after my eyeliner procedure. I understand the actual color of the pigment may be modified slightly, due to the tone and color of my skin. I fully understand this is a tattoo process and therefore n0t an exact science, but an art. 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). 

There is a possibility of an allergic reaction to pigments. A patch test is advisable, however it does not ensure a client will not have an allergic reaction. If waived, I release the technician from liability if I develop an allergic reaction to the pigment.

I consent (initial)

Or waive (initial) 

I understand that if I have any skin treatments, laser hair removal, plastic surgery, or other skin altering procedures, it may result in adverse changes to my permanent cosmetics. 

I acknowledge that any previous microblading/PMU may affect the overall outcome of the shape and/or color of my service due to the technique and product used by previous technician and I may not receive the exact desired shape and/or color. 

I acknowledge some of this potential adverse changes may not be correctable.

I have received pre- and post procedure instructions and I will strictly adhere to such instructions. I understand that my failure to do so may jeopardize my chances for a successful procedure. 

If I am on any medication for depression or any other mood altering prescription, I will advise my technician. 

If I have ever had cold sores, I will consult with and strictly follow my doctor's instructions before contemplating any permanent cosmetic procedure around my lips.

I understand that taking before and after photographs of said procedure(s) are a condition of such procedure(s).

verify I have read and initialed the above paragraphs and have had explained to my understanding this consent and procedure permit.

I accept full responsibility for the decision to have this cosmetic tattoo work done. 

the patch test.

HEALTH INFORMATION

Do you regularly sun bathe or use tanning salons? 

Are you currently under the care of a physician? 

Do you have any of the following medical conditions? (Please select all that apply)

Have you ever had an allergic reaction? (List any and all that you have had and describe the reaction you experienced)