I am over the age of 18, am not under the influence of drugs or alcohol, am not pregnant or nursing and desire to receive the indicated permanent cosmetic procedure. The general nature of cosmetic tattooing as well as the specific procedure to be performed has been explained to me.
I have been informed of the nature, risks, and possible complications and consequences of permanent skin pigmentation. I understand the permanent skin pigmentation procedure carries with it known and unknown complications and consequences associated with this type of cosmentic procedure, including, but not limited to: infections, scarring, inconsistent color, flares, and spreading, fanning or fading of pigments. Cornealabrasions are rare side effect, especially if I rub ir scratch my eyes or apply contacts too soon after eyeliner procedure. I understand the actual color of the pigment maybe modified slightly, due to the tone and color of my skin. I fully understand this is a tattoo process and therefore not an exact science, but an art. I request the permanent skin pigmentation procedure(s) of the said procedure(s).
There is a possibility of an allergic reaction to pigments, anesthetics, and other materials use. A patch test is advisable, however, if does not ensure a client will not have an allerigic reaction. If waived, I release the technician from liability if I develop an allergic reaction to all materials.
I understand 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 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 on individuals prone to this problem. Fading or loss of pigment may occure Secondary infections in the procedure area rarely occurs.
I understand that all instruments that enter the skin or come in contact with body fluids are disposable, and disposed of after use. Cross contamination guidelines are strickly adhered to. Generally, infection are unusual, the area must be kept clean and following strict aftercare provided by the technician.
I understand that if I have any skin treatments, laser hair removal, plasitc surgery or other skin altering procedures, it may result in adverse change to my permanent cosmetics. I acknowledge some of these potential adverse changes may not be correctable.
Depending on the procedure(s) which I select, I accept responsiblity fo determining the color, shape, symmetry, and position of the eyebrows, eyeliner, lips, and/or the color of the camoflage.
I have received pre and post procedure instructions and I will stricly adhere to such instructions. I understand that my failure to do so may jeopardize my chances for a successtul procedure. If I am no any medication for depression or any other mood altering prescription, I will advise my technician. If I have ever had cold sores I will consult with and strickly follow my doctor's instructions before contemplating any permanent cosmetic procedure around my lips.
I understand that I must notify my technician if I am currently using eyelash growth serum and it may cause excessive bleeding during eyeliner procedure.
I understand and accept that the PMU procedure is a process, often requring multiple applications of color to achieve desirable results.
I understand this procedure will result in a permanant change to my apperance.
I understnad that the taking of before and after photographs of the said procedure(s) are a condition of such procedure(s) and might be used for educational purposes and/or published online on our business website and social media accounts. I certify I have read and initialed the above paragraphs and have had explanined to my understanding this consent and procedure permit. I accpet full responsibility for the decision to have this cosmetic tattoo work donw.
If you are a a candidate for Microblading/Permanent Makeup, please note:
- Read all the precare on the website at www.refinedbeautybysuwan.com/book-now
- Do not take Aspirin, Multi-vitamins containing Niacin, fish oils, Vitamin E
- Do not take Ibuprofen or any pain killers unless medically necassary on the day of the procedure and 1-3 days before the procedure. Tylenol is fine.
- Do not use skincare products containing active ingredients or any type of acids/exfoliants on your face starting 1 week prior to your proceure(s).
- Stop using Lash growth serum 1 week prior to eyeliner tattoo procedure.
- Start taking coldsore medication 5 days prior to lip tattoo procedure and continue until lips are healed.
- If you use Accutane, you must be off Accutane for 1 year, NO EXCEPTIONS!!!
- Do not consume alcohol, caffinem, or cannabis the day before and day of procedure.
- Avoid working out of sweating excessively right before and 10 days after procedure.
- If you get your eyebrows waxed or tinted, it is recommended to wait at least 3 days before the procedure.
- Antacids, high blood pressure, thyroid and anxiety medications have been reported as interfering with retention or shifting the pigments to an undersirable tone.
- We have been advised my the AAM PMU Board to not preform any PMU procedure on those in the middle of getting their first 2 COVID -19 shots. It is advised to wait 10 - 14 days after receiving your second shot. And you should not be planning to get your booster shot withint 2 weeks of the procudure or wait 10-14 days after the booster shot has been administered.
PRECAUTIONARY CORONAVIRUS LIABILITY RELEASE FORM
Due to the 2019-2020 outbreak of the novel Coronavirus, COVID-19, we are taking extra precautions with the intake of each client, health history review, as well as sanitation and disinfecting practices. Please complete the following and sign below.
- Dry Cough
- Difficulty Breathing
- No sense of taste and smell
- Body soreness
I agfree to the following:
I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 14 days.
I affirm that I, as well as all household members, have not been diagnosed with COVID-19 within the past 30 days.
I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 withinthe last 30 days.
I affirm that I, as well as all household members, have not traveled outside the United States or to any state or city outside of our own that is or has been considered a "hot spot" for COVID-19 infections within the last 30 days.
I understand that Refined Beauty By Suwan Microblading Studio and Academy can not be held liable for any exposure to the virus or any other contagion caused by misinformation on this form or the health history provided by each client.
I understand that Refined Beauty By Suwan Microblading Studio and Academy can not be held liable for any side effects that may or may not be caused by the COVID-19 vaccination due to it being new and still too many unknowns about the effects of the vaccine and PMU.
By signing below I agree to each above statement and release Refined Beauty By Suwan Microblading Studio and Academy and thier team from any and all liability for the unintentional exposure or harm due to COVID-19.
Your permanent makeup artist and all employees of this facility agree that they abide by these same standards and affirm the same. We also affirm that we have improved and expanded our sanitation protocols to more throughly fight the spread of CODID-19 and other communicable conditions.