I am over the age of 18 and desire Isabel Goulart to perform the elective cosmetic pigmentation procedure, understanding that this procedure is for aesthetic purposes only and not for health reasons. If any unforeseen conditions arise in the course of the procedure calling for her judgment for procedures in addition to, or, different from those now contemplated, I further request and authorize her to do the necessary. I am aware that no guarantees have been made to me concerning the results of the procedure.
I also understand that the permanent skin pigmentation procedure carries with it the possible complications and consequences associated with this type of cosmetic procedure, which includes the risk of infection, scarring, eye damage, inconsistent color, hemorrhage, and possible spreading, fanning or fading of pigments and/or allergic reaction to any products used. I understand the actual color of the pigment may be modified slightly due to the tone and color of my skin. Laser treatments may also compromise the permanent cosmetic make-up application. I fully understand as with all such procedures that this is not a science but an art and that anything that can go wrong. I request the permanent skin pigmentation procedure, appreciating and accepting the permanency of the procedure as well as the possible complications and consequences of the said procedure(s).
For documentation purposes, I also consent to the taking of before, during, and after photographs and/or videos of said procedure(s), which become the technician's sole property and may or not be used for whatever purposes deemed necessary.
I certify that I have read and initiated the above paragraphs and have had it explained, and fully understand the above consent and procedure(s) permit; that the explanations therein referred to were made, and I accept full responsibility for these and/or any other complications which may arise or result during or following the cosmetic procedure(s) which is to be performed at my request.
Procedure: Pixel Brows | Powder Brows No. of visits required: 2
Cost of Procedure: $475.00 First Session $150.00 Touch Up
IF YOU SMOKE, your results will be compromised to some degree. So stop smoking
for a couple of weeks, prior to, and for a couple of weeks following the session. Or
for as long as you can possibly hold out.
WHY? Because the carbon monoxide that has been lovingly added to your cigarettes
has been proven to impede the healing process, by restricting the oxygen content in
your blood... Less oxygen = slower healing time.
Will you heal if you continue to smoke? Yes. It will just take longer, which will allow
more pigment to release, rather than heal in. Will you probably need more followup
I understand that this procedure is a process, and subsequent visits are necessary to achieve desired results.
I will follow all "after-care" instructions thoroughly. Failing to do so will compromise my final results.