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INFORMED CONSENT FORM FOR PERMANENT COSMETICS

Please review the section below, filling in the blanks, and initialing where appropriate. If the client is a minor, the parent or legal guardian should also sign at the bottom of the form.

The nature and method of the proposed Permanent Makeup (Tattoo) procedure involving eyeliner, lip, and/or eyebrows have been explained to me as having the usual risks inherent in the procedure and the possibility of complications during and following its performance. I understand there may be a certain amount of discomfort or pain associated with the procedure and that other adverse side effects may include minor and temporary bleeding, bruising, redness, or other discoloration and swelling; fever blisters may occur on the lips following lip procedures in individuals prone to this problem. Fading or loss of pigment may occur. Secondary infection in the area of the procedure may occur; however, if properly cared for, occurrence is rare.

I acknowledge by signing below, that I have been given the full opportunity to ask any and all questions which I might have about the obtaining of any permanent cosmetic procedures from I Am Eyedolized and/or any associates. I also acknowledge that all of my questions have been answered to my full and total satisfaction. I specifically acknowledge that I have been advised of the fact and matters set below, and I agree as follows:

  • I acknowledge that it is not reasonably possible to determine whether I might have an allergic reaction to any of the pigments, dyes, topical preparations, or processes used in the procedure; and I agree to accept the risk that such a reaction is possible. I have informed the practitioner of any existing problems.

  • I acknowledge that complications are always possible as a result of the Permanent Makeup procedure, particularly in the event that postprocedural instructions are not followed.

  • I realize that my body is unique and the practitioner or any of the practitioner’s associates cannot predict how my skin may react as a result of the procedure.

  • I acknowledge that the procedure will result in a permanent change to my appearance and that no representations have been made to me as to the ability to later change or remove the result.

  • I understand that future laser treatments or other skin-altering procedures, such as plastic surgery, implants, and/or injections may alter and degrade my Permanent Makeup. I further understand that such changes are not the fault of the practitioner and/or any of the practitioner’s associates. I further understand that such changes in my appearance may not be correctable through further Permanent Makeup procedures.

  • For the purposes of education or assistance, I consent to the admittance of authorized observers to the procedure(s).

  • I acknowledge that the obtaining of Permanent Makeup procedure(s) is by my choice alone, and I consent to the application of the procedure and to its attendant risks, and to any actions or conduct of the practitioner and/or any of the practitioner’s associates reasonably necessary to perform the procedure(s).

  • PREGNANCY AND BREAST FEEDING ARE CONTRAINDICATIONS OF THIS PROCEDURE. I acknowledge that I am not pregnant or breast feeding during the time of this procedure. 

I, as herein signed, release, give up, acquit and discharge Eyedolized Brows / Talisa Soto and/ or anyone affiliated with Eyedolized Brows from any claims or damages of any nature. I agree to pay any costs of legal services necessary to further effect or confirm said release. I further agree that this release shall be in contemplation of any possible damages, either known or unknown at the signing of this waiver and release form, and said damages are specifically waived following the signing of this waiver and release form. I further agree to hold my Professional nameless and harmless from any and all damages. I release Talisa Soto from any responsibility for pre- existing conditions I have not revealed, or any consequential change to those conditions that arises subsequent to the procedure. I understand that I am responsible for any medical treatment I may need to receive as a result of getting this procedure. I accept full responsibility for these and any other complications, which may arise or result during or following the permanent makeup procedure, which is to be performed at my request.


I have read and understand the contents of each paragraph above. I acknowledge this is a contract and that I have received no warranties or guarantees with respect to the benefits to be realized from, or consequences of, the aforementioned procedure(s). I further acknowledge that at the time of signing this consent to his procedure(s), I was of sound mind and capable of making independent decisions for myself.

DATE: June 15, 2025


Please review the section below, filling in the blanks, and initialing where appropriate.

LIPLINER / LIP COLOR PRE PROCEDURE ADVICE: 

ALL CLIENTS ARE REQUIRED TO BEGIN DRINKING PLENTY OR WATER AND EXFOLIATING THEIR LIPS WITH A GENTLE SCRUB DAILY BEGINNING 5 DAYS PRIOR TO THEIR PROCEDURE. IF YOUR LIPS ARE CHAPPED WE WILL NOT BE ABLE TO WORK ON THEM. PLEASE LIMIT YOUR CAFFEINE AND ALCOHOL INTAKE AS THIS WILL DEHYDRATE YOUR LIPS. CHAPPED LIPS WILL NOT TAKE COLOR AND WILL ASK AS A MASK. 

All permanent cosmetic procedures are multisession processes. You are required to come back for at least one touch-up visit before it can be determined that your work is complete. Touch-up visits are scheduled from four to six week intervals.

Be prepared for the color intensity of your procedure to be significantly larger, sharper, brighter or darker than what is expected for the final outcome. It will take time for this transition, based on how quickly the outer layer of your skin exfoliates.

Since delicate skin or sensitive areas may swell slightly or redden, some clients feel it best not to make any social plans for a day or two following any procedure.

If you are having lip procedures and have any history of cold sores/fever blisters/herpes simplex, you will be required to contact your physician to obtain the proper prescription medication to prevent such outbreaks. Many physicians prescribe 12 capsules of 500 mg. Valtrex. These can be taken two times a day, two days before micro-pigmentation and four days after, or as physician prescribes. 


PRE-PROCEDURE ADVICE FOR POWDERED BROWS & EYELINER

Powdered brows is a procedure that normally requires multiple treatment sessions. For best results, the client is required to return for at least one perfecting treatment service session and should take place 4-6 weeks after the initial procedure.

Eyeliner No contact lenses are to be worn day of procedure. No eyelash extensions the day of procedure.

To ensure best results, make sure your health is in good condition. Get enough rest, & eat well prior to procedure. No waxing/threading for 72 hours before the procedure as the pores would be open and ink can enter those areas.

24 hours before and after your appointment: avoid alcohol, aspirin and any other related blood thinners unless instructed by your physician.

One week before: Stop taking the following supplements; Vitamin E, B6, Omega 3, Gingko Biloba, & St. John's Wort as they contribute to thinning the blood and may affect anesthetic efficacy. You may resume taking your vitamins after.

On the day of your appointment: Avoid caffeine and exercise. Wash your hair in the morning as you will need to avoid the shower for several days. Baths are recommended.

A color boost is required usually between 12-18 months. A touch-up may be required at 12 months or sooner for oily-skinned clients, those who tan often, or often expose brow area to certain chemicals (facial peels, chlorine, anti-aging products, etc.). Pigment retention varies depending on skin type, age, aftercare, immune system, medications, certain chemicals, and the type of pigment used.


PREGNANCY AND BREAST FEEDING ARE CONTRAINDICATIONS OF THIS PROCEDURE.

If you have any questions please contact me before your appointment

I acknowledge I have read the pre-procedure advice. 





First Client's Name
First Name*
Last Name*
First Client's Age Acknowledgment*
First Client's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Client's Signature*
Second Client's Name
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Client's Date of Birth*
Date of Birth
Third Client's Name
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Client's Date of Birth*
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Fourth Client's Name
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Client's Date of Birth*
Date of Birth
Fifth Client's Name
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Client's Date of Birth*
Date of Birth
Sixth Client's Name
First Name*
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Client's Date of Birth*
Date of Birth
Seventh Client's Name
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Client's Date of Birth*
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Eighth Client's Name
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Client's Date of Birth*
Date of Birth
Ninth Client's Name
First Name*
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Client's Date of Birth*
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Tenth Client's Name
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Client's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
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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*
Last Name*
Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
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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