PMU CONSENT FORM
Procedure(s)
Skin Type
Skin Type:
PLEASE READ AND INITIAL ALL STATEMENTS BELOW
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 posibility of an alergic 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.
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How were you referred to us?
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? (Check all that apply)
Have you ever had an allergic reaction?
What oral medications are you presently taking?
For our female clients:
Are you pregnant or trying to become pregnant?
Are you using contraception?
If yes, are you breastfeeding?
I certify that the preceding medical, medication and personal history statements are true and correct. I am aware that it is my responsibility to inform the doctor or other health professional of my current medical or health conditions and to update this history. A current medical history is essential for the artist to execute appropriate treatment procedures. I represent and certify that I am at least 18 years old and that I have read, understood and agree to be legally bound by the foregoing agreement, waiver, and release.

Thanks for submitting!

For office use only
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Pigments