INFORMED CONSENT TO PROCEDURE FOR PATIENTS
1. I absolutely understand and accept that such procedure is a process, often requiring multiple applications of color to achieve desirable results and the 100% success cannot be guaranteed.
2. Depending on the procedure(s), which I select, I accept responsibility for determining the shape, and position of eyebrows, eyeliners, lipliner and/or full lip color.
3. I understand that the color selection and color results in all procedures are not an exact science.
4. I understand that positioning of my procedures can be affected if I have elected or wish to elect cosmetic surgery, Botox or Restalyne and I assume this responsibility.
5. I am aware that if I am to receive an MRI after the procedure, I must tell the Radiologist that I have iron oxide permanent cosmetics.
6. If I am a lens wearer, I realize that I must keep my lenses out the day of an eyeliner procedure.
7. I understand that this procedure will fade and this fading can alter the original pigment color and that this determines that it is time for a touch-up visit.
8. I realize this is an elective cosmetic procedure and is not medically necessary.
9. It has been explained to me that the following possibilities may occur: Minor and temporary bleeding, bruising, redness or other discoloration; swelling; fever blisters on the lip area following lip procedures and/or fading or loss of pigment.
10. I understand that many lasers & IPL’s (Intense Pulse Lights) including those used for hair removal, anti-aging, Photo Facials, removal of lines may or will turn permanent make up dark or even black. I agree to inform my Technician or anyone operating such that I have permanent make up.
11. I give my consent to confer with my physicians for medical information required for the safety of my procedures.
12. I agree to accompany my practitioner to the emergency room in the event they were to be accidentally stuck with my needle and take a blood test for their safety & disclose all test results to my practitioner.
13. I am aware that if an infection occurs after I have received Permanent Cosmetics to see with my primary physician or an emergency room, immediately.
14. If I had permanent cosmetics performed previously by another practitioner, I do not hold responsible for future allergic reactions or contraindications.
15. If I am having microblading procedure performed, I understand I must stop using all anti-aging products and products that contain Retins, acids (Hyaluronic, Glycolic, etc.) 6 weeks prior to the procedure.
16. If I am having permanent makeup (powder brows, ombre brows, etc.) procedure performed, I understand I must stop using all anti-aging products and products that contain Retins, acids (Hyaluronic, Glycolic, etc.) 10 days prior to the procedure.
I have read and understand these risks listed above and they have been explained to me. I DID NOT JUST SIGN THIS DOCUMENT. I certify that the information in the above questionnaire is accurate, and my questions have been answered. I accept full responsibility for any complications that may arise or result during or following the cosmetic procedure(s) to be performed at my request.