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Framed Beauty Company PMU Consent Form

10614 Providence Rd. Charlotte, NC 28277

This document outlines and confirms your understanding, safety and health protocols of all permanent makeup services and includes information regarding:

  • Possible Risks, Hazards, or Complications
  • Policies
  • Care and Maintenance
  • Consent & Release Agreement
  • Photo Release Agreement
  • Coronavirus Liability Release





Thank you for choosing Framed Beauty Co. for your permanent makeup experience.

Client's information and signature is required according to North Carolina's Department of Health and Human Services Division of Public Health and driver's license information is required to verify age for services (18+ years old). 

Please read the following information and instructions to ensure the best results for your treatment. 

PRE-CARE INSTRUCTIONS:

7 Days Before Appointment:

  • Discontinue: Vitamin E, Fish Oil, Turmeric

48 Hours Before:

  • Avoid: Alcohol, Aspirin, Ibuprofen, Aleve

24 Hours Before:

  • Avoid: Caffeine, energy drinks, soda, and coffee

All of the products mentioned above results in excessive bleeding and will negatively affect the longevity of your semi-permanent makeup application. Failure to follow pre-care may negatively impact results and could lead to early termination of your session.


Lip Blush Treatment:

If you’re prone to cold sores, we recommend taking Lysine, Valtrex, or Zovirax 3–5 days before and 5 days after your appointment.


POSSIBLE RISKS, HAZARDS & COMPLICATIONS

Allergic Reactions - Although rare, are possible and can occur with anesthetics (ingredients may contain lidocaine, tetracaine, epinephrine), pigments, and dyes used during PMU treatments. 

Pain & Numbness - Each client responds to anesthetics differently according to skin type. You can expect to experience some discomfort although clients report little to no pain. 

Uneven Pigmentation - Results from poor healing, infection, bleeding or many other causes. Final adjustments can be made at the touch-up session.

MRI - Some pigments may contain inert oxides. You must inform the MRI technician of any cosmetic tattoo treatments. A low level magnet may be required if a scan is necessary.

Possible Infections - Infections are VERY RARE. We use only sterile disposable tools, medical grade disinfectants and adhere to all health protocols/guidelines. 

It is highly crucial to follow aftercare instructions properly to prevent any adverse reactions or infections. 

 

CARE & MAINTENANCE

It is vital to follow aftercare instructions to ensure your best results, proper healing and color retention. 

Aftercare instructions will be communicated verbally in detail at the end of your treatment, included in your aftercare kit and is also available on our website. 

 

What to expect for the first 10 days after the PMU treatment

First 2 days: The color will be a little dark. Slight swelling, thickness, and/or redness for 1-2 days following the treatment.

After about 6 days: The color will appear to be very light

After 10 days: The color will resolve itself to its appropriate shade

 

PMU General Healing Expectations

●  Color will soften as it heals; 30–50% pigment loss is normal.

●  Full healing takes approximately 30–45 days.

●  A touch-up at 6–12 weeks will refine and perfect the results.

● Eyebrows/lips/eyeliner will appear darker and 10–15% larger initially.

●  Natural exfoliation will lighten pigment and reduce treated area size.

●  Temporary darkness and fullness are part of the normal healing process.

 

Angel Tattoo Removal

The first removal product specifically designed for eyebrows. 

A non-laser, manual technique, designed to safely remove 99.9% of all tattoo pigments from the skin. In particular, pigments from permanent makeup. 

Angel Removal uses active ingredients from acids of antioxidant fruits to attract pigment toward the skin's surface to be eliminated. 

Great for existing PMU that has changed color, is overly saturated/dark and for correction. 

Angel Removal General Healing Expectations

●  Results can be seen in 2-3 weeks.

●   Pigment can continue to leave the area for up to 30 days.

●   Depending on the depth and color of the existing tattoo, more than 1 session may be required to see optimal results.


I understand that results for permanent makeup and removal are not guaranteed, as pigment retention varies by individual. Factors like oily, acne-prone, textured, thin, or sensitive skin can affect outcomes.

I understand that Angel Tattoo Removal is a non-laser, manual technique using fruit-based acids to safely lift pigment from the skin.

I understand that permanent makeup yields a natural look and that eyebrow pencil, powder, or lipstick may still be needed.

I understand the artist will recommend the most suitable treatment for my skin type and lifestyle. Choosing a service against professional advice may lead to suboptimal results.

I understand permanent makeup is a two-step process, requiring a touch-up 6–12 weeks after the initial session for best results.

I understand the artist cannot control the healing process, and additional touch-ups or sessions (at an additional fee) may be required—especially if correcting or covering old PMU.

I understand healing may include patchiness and unevenness, and can take up to 45 days. Final results and pigment color vary by skin tone, skin type, age, and condition.

I understand that 50% of my results depend on how well I follow aftercare instructions. Failure to do so may result in poor retention, scarring, or permanent skin damage.

I understand the treatment is semi-permanent and may last 1–3 years, depending on skin type, lifestyle, medications, and aftercare. Regular touch-ups may be needed to maintain color and shape.

I understand that products like Retinol, Retin-A, Tretinoin, glycolic, salicylic, and lactic acids, as well as sun exposure, tanning, and certain medications, can affect my results.

I Agree

 

POLICIES

I understand that there is a NON-REFUNDABLE but transferable booking fee to secure my appointment, which will be credited toward the overall cost of my treatment. 

I understand that a 72-hours notice is required to reschedule my appointment. Failure to give a 72-hour notice will forfeit my booking fee, and an additional $75.00 NON-REFUNDABLE booking fee will be required to secure another appointment. 

The remaining balance will be processed on the day of your treatment. We accept payments by Visa, MasterCard, American Express, Cash or Debit Cards, Zelle, and Venmo. No Checks accepted. 

If I decide to cancel or fail to show up to my appointment, I will automatically forfeit my booking fee. If I am more than 15 minutes late, my appointment may need to be rescheduled. 

I UNDERSTAND THAT ALL TRANSACTIONS ARE FINAL. NO REFUNDS WILL BE ISSUED. 


I understand that the artist, Kathy Nguyen, can release me as a client at any time if I am not compliant with the policies.


 

CONSENT & RELEASE AGREEMENT

I am over the age of 18, am not under the influence of drugs or alcohol, I am not pregnant and desire to receive permanent makeup services. If I am actively nursing, I agree to pump and dump for 48 hours after my appointment. The general nature of cosmetic tattooing, as well as the specific treatment performed has been explained to me. 

I have been informed of the nature, risks, and possible complications and consequences of cosmetic tattooing. Permanent makeup services carries known and unknown complications and consequences including but not limited to: infection, scarring, inconsistent color, and spreading or fading of pigments. 

I accept the responsibility for determining the color, shape, and position of the treatment as agreed during the consultation. 

I understand the actual color of the pigments may be modified slightly due to the tone and color of my skin. I fully understand this is a tattoo process and therefore not a science but an art. 

I certify that I have read the consent form in its entirety. I understand the risks involved in this treatment(s) and have been given the full opportunity to ask any and all questions about cosmetic tattooing, Angel Removal, its process and any risks involved from Kathy Nguyen. Therefore, I release any and all legal liability.

I Agree

 

PHOTO RELEASE

I understand that the taking of before and after photographs might be used for educational purposes and/or published online on our business website and social media accounts. If you are not comfortable with your photos being published, please notify us at your appointment. 

I understand that the taking of before and after photographs is required for professional and confidential files.

I Agree

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Confidential Medical Profile
What type of skin do you have? *
Dry
Normal
Combination
Oily
Do you have previous Permanent Make Up?*
No
Yes

If yes when?
Are you pregnant?*
No
Yes
Are you nursing?*
No
Yes
Do you have Epilepsy/Seizures of any kind?*
No
Yes
Have you had Botox or injectables?*
No
Yes

If yes, when and what area(s)?
Do you currently or have you had Cancer?*
No
Yes

If yes, please explain?
Are you currently undergoing radiation or chemotherapy?*
No
Yes
Have you had chemical or laser peels?*
No
Yes

If yes, when?
Have you had Aspirin or any blood thinning medications/supplements within the last 7 days?*
No
Yes
Do you take Antidepressants or mood altering medication?*
No
Yes
Do you have any problems with healing?*
No
Yes
Do you get fever blisters or cold sores?*
No
Yes
Are you currently using Retin-A, Retinol/Retinoids, Tretinoin, or Alpha Hydroxyl skin care products?*
No
Yes
Do you wear contact lenses?*
No
Yes
Have you had caffeine products in the last 24 hours?*
No
Yes
Have you consumed alcohol in the last 48 hours?*
No
Yes
Are you taking any medication, including immunosuppressive, such as anti-inflammatory or steroids?*
No
Yes
Are you allergic to topical antibiotic preparation? e.g. Polysporin, Bacitracin, Neosporin, or Caine family of drugs or Petroleum based products (Vaseline)?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you presently taking Vitamins A, E or fish oil in any form?*
No
Yes
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any heart conditions?*
No
Yes
Do you have Alopecia?*
No
Yes
Do you have Trichotillomania?*
No
Yes
Are you currently on Accutane Treatment?*
No
Yes
Do you have Keloid or Hypertrophy Scars?*
No
Yes
Do you have Diabetes?*
No
Yes
Any tendency to bleed excessively from minor cuts?*
No
Yes

For your safety, please inform us of any medical conditions:
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Confidential Medical Profile
What type of skin do you have? *
Dry
Normal
Combination
Oily
Do you have previous Permanent Make Up?*
No
Yes

If yes when?
Are you pregnant?*
No
Yes
Are you nursing?*
No
Yes
Do you have Epilepsy/Seizures of any kind?*
No
Yes
Have you had Botox or injectables?*
No
Yes

If yes, when and what area(s)?
Do you currently or have you had Cancer?*
No
Yes

If yes, please explain?
Are you currently undergoing radiation or chemotherapy?*
No
Yes
Have you had chemical or laser peels?*
No
Yes

If yes, when?
Have you had Aspirin or any blood thinning medications/supplements within the last 7 days?*
No
Yes
Do you take Antidepressants or mood altering medication?*
No
Yes
Do you have any problems with healing?*
No
Yes
Do you get fever blisters or cold sores?*
No
Yes
Are you currently using Retin-A, Retinol/Retinoids, Tretinoin, or Alpha Hydroxyl skin care products?*
No
Yes
Do you wear contact lenses?*
No
Yes
Have you had caffeine products in the last 24 hours?*
No
Yes
Have you consumed alcohol in the last 48 hours?*
No
Yes
Are you taking any medication, including immunosuppressive, such as anti-inflammatory or steroids?*
No
Yes
Are you allergic to topical antibiotic preparation? e.g. Polysporin, Bacitracin, Neosporin, or Caine family of drugs or Petroleum based products (Vaseline)?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you presently taking Vitamins A, E or fish oil in any form?*
No
Yes
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any heart conditions?*
No
Yes
Do you have Alopecia?*
No
Yes
Do you have Trichotillomania?*
No
Yes
Are you currently on Accutane Treatment?*
No
Yes
Do you have Keloid or Hypertrophy Scars?*
No
Yes
Do you have Diabetes?*
No
Yes
Any tendency to bleed excessively from minor cuts?*
No
Yes

For your safety, please inform us of any medical conditions:
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Confidential Medical Profile
What type of skin do you have? *
Dry
Normal
Combination
Oily
Do you have previous Permanent Make Up?*
No
Yes

If yes when?
Are you pregnant?*
No
Yes
Are you nursing?*
No
Yes
Do you have Epilepsy/Seizures of any kind?*
No
Yes
Have you had Botox or injectables?*
No
Yes

If yes, when and what area(s)?
Do you currently or have you had Cancer?*
No
Yes

If yes, please explain?
Are you currently undergoing radiation or chemotherapy?*
No
Yes
Have you had chemical or laser peels?*
No
Yes

If yes, when?
Have you had Aspirin or any blood thinning medications/supplements within the last 7 days?*
No
Yes
Do you take Antidepressants or mood altering medication?*
No
Yes
Do you have any problems with healing?*
No
Yes
Do you get fever blisters or cold sores?*
No
Yes
Are you currently using Retin-A, Retinol/Retinoids, Tretinoin, or Alpha Hydroxyl skin care products?*
No
Yes
Do you wear contact lenses?*
No
Yes
Have you had caffeine products in the last 24 hours?*
No
Yes
Have you consumed alcohol in the last 48 hours?*
No
Yes
Are you taking any medication, including immunosuppressive, such as anti-inflammatory or steroids?*
No
Yes
Are you allergic to topical antibiotic preparation? e.g. Polysporin, Bacitracin, Neosporin, or Caine family of drugs or Petroleum based products (Vaseline)?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you presently taking Vitamins A, E or fish oil in any form?*
No
Yes
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any heart conditions?*
No
Yes
Do you have Alopecia?*
No
Yes
Do you have Trichotillomania?*
No
Yes
Are you currently on Accutane Treatment?*
No
Yes
Do you have Keloid or Hypertrophy Scars?*
No
Yes
Do you have Diabetes?*
No
Yes
Any tendency to bleed excessively from minor cuts?*
No
Yes

For your safety, please inform us of any medical conditions:
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Confidential Medical Profile
What type of skin do you have? *
Dry
Normal
Combination
Oily
Do you have previous Permanent Make Up?*
No
Yes

If yes when?
Are you pregnant?*
No
Yes
Are you nursing?*
No
Yes
Do you have Epilepsy/Seizures of any kind?*
No
Yes
Have you had Botox or injectables?*
No
Yes

If yes, when and what area(s)?
Do you currently or have you had Cancer?*
No
Yes

If yes, please explain?
Are you currently undergoing radiation or chemotherapy?*
No
Yes
Have you had chemical or laser peels?*
No
Yes

If yes, when?
Have you had Aspirin or any blood thinning medications/supplements within the last 7 days?*
No
Yes
Do you take Antidepressants or mood altering medication?*
No
Yes
Do you have any problems with healing?*
No
Yes
Do you get fever blisters or cold sores?*
No
Yes
Are you currently using Retin-A, Retinol/Retinoids, Tretinoin, or Alpha Hydroxyl skin care products?*
No
Yes
Do you wear contact lenses?*
No
Yes
Have you had caffeine products in the last 24 hours?*
No
Yes
Have you consumed alcohol in the last 48 hours?*
No
Yes
Are you taking any medication, including immunosuppressive, such as anti-inflammatory or steroids?*
No
Yes
Are you allergic to topical antibiotic preparation? e.g. Polysporin, Bacitracin, Neosporin, or Caine family of drugs or Petroleum based products (Vaseline)?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you presently taking Vitamins A, E or fish oil in any form?*
No
Yes
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any heart conditions?*
No
Yes
Do you have Alopecia?*
No
Yes
Do you have Trichotillomania?*
No
Yes
Are you currently on Accutane Treatment?*
No
Yes
Do you have Keloid or Hypertrophy Scars?*
No
Yes
Do you have Diabetes?*
No
Yes
Any tendency to bleed excessively from minor cuts?*
No
Yes

For your safety, please inform us of any medical conditions:
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Confidential Medical Profile
What type of skin do you have? *
Dry
Normal
Combination
Oily
Do you have previous Permanent Make Up?*
No
Yes

If yes when?
Are you pregnant?*
No
Yes
Are you nursing?*
No
Yes
Do you have Epilepsy/Seizures of any kind?*
No
Yes
Have you had Botox or injectables?*
No
Yes

If yes, when and what area(s)?
Do you currently or have you had Cancer?*
No
Yes

If yes, please explain?
Are you currently undergoing radiation or chemotherapy?*
No
Yes
Have you had chemical or laser peels?*
No
Yes

If yes, when?
Have you had Aspirin or any blood thinning medications/supplements within the last 7 days?*
No
Yes
Do you take Antidepressants or mood altering medication?*
No
Yes
Do you have any problems with healing?*
No
Yes
Do you get fever blisters or cold sores?*
No
Yes
Are you currently using Retin-A, Retinol/Retinoids, Tretinoin, or Alpha Hydroxyl skin care products?*
No
Yes
Do you wear contact lenses?*
No
Yes
Have you had caffeine products in the last 24 hours?*
No
Yes
Have you consumed alcohol in the last 48 hours?*
No
Yes
Are you taking any medication, including immunosuppressive, such as anti-inflammatory or steroids?*
No
Yes
Are you allergic to topical antibiotic preparation? e.g. Polysporin, Bacitracin, Neosporin, or Caine family of drugs or Petroleum based products (Vaseline)?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you presently taking Vitamins A, E or fish oil in any form?*
No
Yes
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any heart conditions?*
No
Yes
Do you have Alopecia?*
No
Yes
Do you have Trichotillomania?*
No
Yes
Are you currently on Accutane Treatment?*
No
Yes
Do you have Keloid or Hypertrophy Scars?*
No
Yes
Do you have Diabetes?*
No
Yes
Any tendency to bleed excessively from minor cuts?*
No
Yes

For your safety, please inform us of any medical conditions:
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Confidential Medical Profile
What type of skin do you have? *
Dry
Normal
Combination
Oily
Do you have previous Permanent Make Up?*
No
Yes

If yes when?
Are you pregnant?*
No
Yes
Are you nursing?*
No
Yes
Do you have Epilepsy/Seizures of any kind?*
No
Yes
Have you had Botox or injectables?*
No
Yes

If yes, when and what area(s)?
Do you currently or have you had Cancer?*
No
Yes

If yes, please explain?
Are you currently undergoing radiation or chemotherapy?*
No
Yes
Have you had chemical or laser peels?*
No
Yes

If yes, when?
Have you had Aspirin or any blood thinning medications/supplements within the last 7 days?*
No
Yes
Do you take Antidepressants or mood altering medication?*
No
Yes
Do you have any problems with healing?*
No
Yes
Do you get fever blisters or cold sores?*
No
Yes
Are you currently using Retin-A, Retinol/Retinoids, Tretinoin, or Alpha Hydroxyl skin care products?*
No
Yes
Do you wear contact lenses?*
No
Yes
Have you had caffeine products in the last 24 hours?*
No
Yes
Have you consumed alcohol in the last 48 hours?*
No
Yes
Are you taking any medication, including immunosuppressive, such as anti-inflammatory or steroids?*
No
Yes
Are you allergic to topical antibiotic preparation? e.g. Polysporin, Bacitracin, Neosporin, or Caine family of drugs or Petroleum based products (Vaseline)?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you presently taking Vitamins A, E or fish oil in any form?*
No
Yes
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any heart conditions?*
No
Yes
Do you have Alopecia?*
No
Yes
Do you have Trichotillomania?*
No
Yes
Are you currently on Accutane Treatment?*
No
Yes
Do you have Keloid or Hypertrophy Scars?*
No
Yes
Do you have Diabetes?*
No
Yes
Any tendency to bleed excessively from minor cuts?*
No
Yes

For your safety, please inform us of any medical conditions:
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Confidential Medical Profile
What type of skin do you have? *
Dry
Normal
Combination
Oily
Do you have previous Permanent Make Up?*
No
Yes

If yes when?
Are you pregnant?*
No
Yes
Are you nursing?*
No
Yes
Do you have Epilepsy/Seizures of any kind?*
No
Yes
Have you had Botox or injectables?*
No
Yes

If yes, when and what area(s)?
Do you currently or have you had Cancer?*
No
Yes

If yes, please explain?
Are you currently undergoing radiation or chemotherapy?*
No
Yes
Have you had chemical or laser peels?*
No
Yes

If yes, when?
Have you had Aspirin or any blood thinning medications/supplements within the last 7 days?*
No
Yes
Do you take Antidepressants or mood altering medication?*
No
Yes
Do you have any problems with healing?*
No
Yes
Do you get fever blisters or cold sores?*
No
Yes
Are you currently using Retin-A, Retinol/Retinoids, Tretinoin, or Alpha Hydroxyl skin care products?*
No
Yes
Do you wear contact lenses?*
No
Yes
Have you had caffeine products in the last 24 hours?*
No
Yes
Have you consumed alcohol in the last 48 hours?*
No
Yes
Are you taking any medication, including immunosuppressive, such as anti-inflammatory or steroids?*
No
Yes
Are you allergic to topical antibiotic preparation? e.g. Polysporin, Bacitracin, Neosporin, or Caine family of drugs or Petroleum based products (Vaseline)?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you presently taking Vitamins A, E or fish oil in any form?*
No
Yes
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any heart conditions?*
No
Yes
Do you have Alopecia?*
No
Yes
Do you have Trichotillomania?*
No
Yes
Are you currently on Accutane Treatment?*
No
Yes
Do you have Keloid or Hypertrophy Scars?*
No
Yes
Do you have Diabetes?*
No
Yes
Any tendency to bleed excessively from minor cuts?*
No
Yes

For your safety, please inform us of any medical conditions:
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Confidential Medical Profile
What type of skin do you have? *
Dry
Normal
Combination
Oily
Do you have previous Permanent Make Up?*
No
Yes

If yes when?
Are you pregnant?*
No
Yes
Are you nursing?*
No
Yes
Do you have Epilepsy/Seizures of any kind?*
No
Yes
Have you had Botox or injectables?*
No
Yes

If yes, when and what area(s)?
Do you currently or have you had Cancer?*
No
Yes

If yes, please explain?
Are you currently undergoing radiation or chemotherapy?*
No
Yes
Have you had chemical or laser peels?*
No
Yes

If yes, when?
Have you had Aspirin or any blood thinning medications/supplements within the last 7 days?*
No
Yes
Do you take Antidepressants or mood altering medication?*
No
Yes
Do you have any problems with healing?*
No
Yes
Do you get fever blisters or cold sores?*
No
Yes
Are you currently using Retin-A, Retinol/Retinoids, Tretinoin, or Alpha Hydroxyl skin care products?*
No
Yes
Do you wear contact lenses?*
No
Yes
Have you had caffeine products in the last 24 hours?*
No
Yes
Have you consumed alcohol in the last 48 hours?*
No
Yes
Are you taking any medication, including immunosuppressive, such as anti-inflammatory or steroids?*
No
Yes
Are you allergic to topical antibiotic preparation? e.g. Polysporin, Bacitracin, Neosporin, or Caine family of drugs or Petroleum based products (Vaseline)?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you presently taking Vitamins A, E or fish oil in any form?*
No
Yes
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any heart conditions?*
No
Yes
Do you have Alopecia?*
No
Yes
Do you have Trichotillomania?*
No
Yes
Are you currently on Accutane Treatment?*
No
Yes
Do you have Keloid or Hypertrophy Scars?*
No
Yes
Do you have Diabetes?*
No
Yes
Any tendency to bleed excessively from minor cuts?*
No
Yes

For your safety, please inform us of any medical conditions:
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Confidential Medical Profile
What type of skin do you have? *
Dry
Normal
Combination
Oily
Do you have previous Permanent Make Up?*
No
Yes

If yes when?
Are you pregnant?*
No
Yes
Are you nursing?*
No
Yes
Do you have Epilepsy/Seizures of any kind?*
No
Yes
Have you had Botox or injectables?*
No
Yes

If yes, when and what area(s)?
Do you currently or have you had Cancer?*
No
Yes

If yes, please explain?
Are you currently undergoing radiation or chemotherapy?*
No
Yes
Have you had chemical or laser peels?*
No
Yes

If yes, when?
Have you had Aspirin or any blood thinning medications/supplements within the last 7 days?*
No
Yes
Do you take Antidepressants or mood altering medication?*
No
Yes
Do you have any problems with healing?*
No
Yes
Do you get fever blisters or cold sores?*
No
Yes
Are you currently using Retin-A, Retinol/Retinoids, Tretinoin, or Alpha Hydroxyl skin care products?*
No
Yes
Do you wear contact lenses?*
No
Yes
Have you had caffeine products in the last 24 hours?*
No
Yes
Have you consumed alcohol in the last 48 hours?*
No
Yes
Are you taking any medication, including immunosuppressive, such as anti-inflammatory or steroids?*
No
Yes
Are you allergic to topical antibiotic preparation? e.g. Polysporin, Bacitracin, Neosporin, or Caine family of drugs or Petroleum based products (Vaseline)?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you presently taking Vitamins A, E or fish oil in any form?*
No
Yes
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any heart conditions?*
No
Yes
Do you have Alopecia?*
No
Yes
Do you have Trichotillomania?*
No
Yes
Are you currently on Accutane Treatment?*
No
Yes
Do you have Keloid or Hypertrophy Scars?*
No
Yes
Do you have Diabetes?*
No
Yes
Any tendency to bleed excessively from minor cuts?*
No
Yes

For your safety, please inform us of any medical conditions:
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Confidential Medical Profile
What type of skin do you have? *
Dry
Normal
Combination
Oily
Do you have previous Permanent Make Up?*
No
Yes

If yes when?
Are you pregnant?*
No
Yes
Are you nursing?*
No
Yes
Do you have Epilepsy/Seizures of any kind?*
No
Yes
Have you had Botox or injectables?*
No
Yes

If yes, when and what area(s)?
Do you currently or have you had Cancer?*
No
Yes

If yes, please explain?
Are you currently undergoing radiation or chemotherapy?*
No
Yes
Have you had chemical or laser peels?*
No
Yes

If yes, when?
Have you had Aspirin or any blood thinning medications/supplements within the last 7 days?*
No
Yes
Do you take Antidepressants or mood altering medication?*
No
Yes
Do you have any problems with healing?*
No
Yes
Do you get fever blisters or cold sores?*
No
Yes
Are you currently using Retin-A, Retinol/Retinoids, Tretinoin, or Alpha Hydroxyl skin care products?*
No
Yes
Do you wear contact lenses?*
No
Yes
Have you had caffeine products in the last 24 hours?*
No
Yes
Have you consumed alcohol in the last 48 hours?*
No
Yes
Are you taking any medication, including immunosuppressive, such as anti-inflammatory or steroids?*
No
Yes
Are you allergic to topical antibiotic preparation? e.g. Polysporin, Bacitracin, Neosporin, or Caine family of drugs or Petroleum based products (Vaseline)?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you presently taking Vitamins A, E or fish oil in any form?*
No
Yes
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any heart conditions?*
No
Yes
Do you have Alopecia?*
No
Yes
Do you have Trichotillomania?*
No
Yes
Are you currently on Accutane Treatment?*
No
Yes
Do you have Keloid or Hypertrophy Scars?*
No
Yes
Do you have Diabetes?*
No
Yes
Any tendency to bleed excessively from minor cuts?*
No
Yes

For your safety, please inform us of any medical conditions:
Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Confidential Medical Profile
What type of skin do you have? *
Dry
Normal
Combination
Oily
Do you have previous Permanent Make Up?*
No
Yes

If yes when?
Are you pregnant?*
No
Yes
Are you nursing?*
No
Yes
Do you have Epilepsy/Seizures of any kind?*
No
Yes
Have you had Botox or injectables?*
No
Yes

If yes, when and what area(s)?
Do you currently or have you had Cancer?*
No
Yes

If yes, please explain?
Are you currently undergoing radiation or chemotherapy?*
No
Yes
Have you had chemical or laser peels?*
No
Yes

If yes, when?
Have you had Aspirin or any blood thinning medications/supplements within the last 7 days?*
No
Yes
Do you take Antidepressants or mood altering medication?*
No
Yes
Do you have any problems with healing?*
No
Yes
Do you get fever blisters or cold sores?*
No
Yes
Are you currently using Retin-A, Retinol/Retinoids, Tretinoin, or Alpha Hydroxyl skin care products?*
No
Yes
Do you wear contact lenses?*
No
Yes
Have you had caffeine products in the last 24 hours?*
No
Yes
Have you consumed alcohol in the last 48 hours?*
No
Yes
Are you taking any medication, including immunosuppressive, such as anti-inflammatory or steroids?*
No
Yes
Are you allergic to topical antibiotic preparation? e.g. Polysporin, Bacitracin, Neosporin, or Caine family of drugs or Petroleum based products (Vaseline)?*
No
Yes
Is there any history of skin diseases or remarkable skin sensitivities?*
No
Yes
Are you presently taking Vitamins A, E or fish oil in any form?*
No
Yes
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any heart conditions?*
No
Yes
Do you have Alopecia?*
No
Yes
Do you have Trichotillomania?*
No
Yes
Are you currently on Accutane Treatment?*
No
Yes
Do you have Keloid or Hypertrophy Scars?*
No
Yes
Do you have Diabetes?*
No
Yes
Any tendency to bleed excessively from minor cuts?*
No
Yes

For your safety, please inform us of any medical conditions:
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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