INFORMED CONSENT TO PROCEDURE
1. I absolutely understand and accept that such procedure is a process, often requiring multiple applications of color to achieve desirable results. 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 permanent cosmetics.
6. If I am a contact lens wearer, I realize that I must keep my contact lenses out the day of an eyeliner procedure.
7. I understand that this procedure will fade. This fading can alter the original pigment color, and 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; and/or fading or loss of pigment.
10. I understand that many lasers & IPL’s (Intense Pulse Lights) including those used for hair removal or Photo Facials, may or will turn permanent make up dark or even black. I agree to inform my practitioner that I have permanent make up.
11. 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.
12. I am aware that if an infection occurs after I have received permanent cosmetics, I am to see my primary physician or an emergency room, immediately.
13. If I had permanent cosmetics performed previously by another practitioner, I do not hold BMA responsible for future allergic reactions or contraindications.
If I am having a microblading or permanent brow procedure performed, I understand I must stop using all anti-aging products and products that contain retins, acids (Hyaluronic, Glycolic, etc.), vitamins A - C - E, 6 weeks prior to the procedure. Please call the Academie if you need to reschedule to allow for the 6 weeks to expire.
If I am having an eyeliner procedure performed,I understand I must stop using lash growth serums and must remove lash extensions, 2 weeks prior to the procedure. Please call the Academie if you need to reschedule to allow for the 2 weeks to expire.
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.