INFORMED CONSENT FORM Although every precaution will be taken to ensure your safety and well-being before, during, and after your treatment/procedure, please be aware of the following information and possible risks and indicate that you fully understand what to expect. Please initial: I hereby consent to and authorize the technician/esthetician to perform the following treatment/procedure: Permanent Cosmetics Tattoo I voluntarily agree to undergo this treatment/procedure after the nature and purpose of this treatment/procedure has been explained to me, along with the risks and hazards involved. Although it is impossible to list every potential risk and complication, I have been informed of possible benefits, risks, and complications. I understand that it is imperative to my health and safety that I disclose all of the information requested in the Client Consultation/Health History form. I have cited all conditions and circumstances regarding my health history, allergies, and medications, supplements, or prescriptions being taken (orally and/or topically), and any past reactions to products or medications. I understand that no specific guarantees of the results can or have been made and that there is the possibility I may require additional treatments/procedures to obtain the expected results at an additional cost. I have read and understand all pre-treatment, post-treatment, and home care instructions. I understand the importance of following all instructions given to me. In the event that I have additional questions or concerns regarding my treatment or post-treatment care, I will consult the technician/esthetician immediately. I understand that if I choose to consult a physician, I do so at my own expense. I consent to “before-and-after” photographs for the purpose of documentation, potential advertising, and promotional purposes. I understand that if I have any concerns, I will address these with my technician/esthetician. I give permission to my technician/esthetician to perform the above treatment/procedure we have discussed and will hold him/her/them and his/her/their staff harmless and nameless from any liability that may result from this treatment/procedure. I understand my technician/esthetician will take every precaution to minimize or eliminate negative reactions as much as possible. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that I have read and fully understand the above paragraphs and that I have been provided sufficient opportunity for discussion and to have any questions answered. I understand the procedure and accept the risks. I do not hold the technician/esthetician, whose signature appears below, responsible for any of my conditions that were present but not disclosed at the time of this procedure that may be affected by the treatment performed today. Client Signature: Date: April 2, 2026 Please read these statements carefully: Permanent cosmetics and Micro-Tattooing. • Re-touch procedures are nearly always required following the initial procedure; please note this is a two-stage tattoo process, color retention holds much stronger following the retouch. Beauty Realm LLC and its Artists STRONGLY encourage that you make your touch up appointment at the time of your initial procedure. •A minimum healing period of 6-8 weeks Is required before a re-touch procedure can be performed depending on age and skin type.
• A healed result can be seen 4-6 weeks after the treatment.
• Retention of pigment depends on many factors including, skin type, age of client, adhering to aftercare procedure, lifestyle, sun exposure, medication and vitamins. • On rare occasions the pigment may migrate under the skin regardless of skin types.
• Old Scaring may act like 'dead skin' for the ink and often times will not hold pigment • Application of permanent cosmetics can be painful. Pain tolerance will vary from person to person.
• Immediately after the procedure, the pigment can be 30 to 50% darker than the desired result. • There may be immediate or delayed allergic reaction to pigments. However, allergic reactions are extremely rare.
• A negative allergy test result will not guarantee that you will not have an allergic reaction.
• Allergic reactions to anesthetics can occur. Please Inform your artist If you have had an allergic reaction in the past.
• Permanent cosmetics cannot be applied to pregnant women or nursing mothers.
• Permanent cosmetics cannot be applied to any person under the age of eighteen.
• Infections can occur If aftercare Instructions are not followed correctly.
• There may be swelling and redness following the procedure.
• You may experience minor bleeding.
• If you have an MRI scan within 3 months of your permanent cosmetics procedure we recommend that you discuss this with your doctor.
• Possible scarring, inconsistency of color.
• It is normal for the top layer to flake off, DO NOT PICK, as you will rip off the deeper layers of pigment with It and it will have no retention.
Eyeliner Procedures:
• Corneal abrasion may occur during eyeliner procedures. However, corneal abrasion is rare.
Lip Procedures:
• Clients receiving lip procedures who have had previous problems with cold sores/herpes may have an outbreak following the procedure. Anti-viral medication must be obtained from your physician prior to your appointment
• Lip procedures may appear dry and flaky for up to one week following the procedure.
What to expect Immediately after your tattoo:
•Day 1:
Eyebrows: the brows will appear slightly thicker and the color will look much stronger/warmer due to the redness caused in the skin.
Eyeliner: The skin round the eye may appear swollen and red due to the stretching and implantation of ink into a sensitive area.
Lip: will appear stronger in color and swollen. The main swelling will subside within a few hours as this is mainly due to the aesthetic applied. Swelling from the procedure will subside within 48 hours. Ice helps. •Day 2-4:
The brows will appear 2 shades darker from when you left the treatment room and color may seem a little red still. Lips also will appear up to 50% darker/brighter than the final healed result is actually going to be. They may also feel rough and dry.
• Day 6-12: Brows & liner may look very light and patchy at this stage. The pigment will reappear in nearly all cases. Lips may begin to flake
• Day 21-30: Depending on the client, this is the time when you actually start to see the final result People who heal quickly can see their final color by the 4-5 week mark, while more mature skin and slower healers may have to wait 6-8 weeks to see the color fully bloomed back.
• As time passes the pigment will appear softer and lighter as it settles under the layers of skin. To protect against fading use a sunscreen. avoid sunbeds and cut down on vitamin C, Glycolic acid directly on treatment area. This information is not intended to alarm you. However, it is imperative that you are informed of the risks involved and that YOU FOLLOW THE STRICT AFTERCARE INSTRUCTIONS. I HAVE READ AND UNDERSTAND THE INFORMATION ABOVE. I AGREE TO FOLLOW THE AFTERCARE PROCEDURES GIVEN TO ME DURING MY TREATMENT FOR BOTH MY INITIAL AND RETOUCH PROCEDURE. Date: April 2, 2026 Client Signature:
Informed Consent Form
I am over the age of 18, am not under the influence of drugs or alcohol, I am not pregnant or nursing and desire to receive the indicated permanent pigmentation procedure. The general nature of cosmetic micro-pigmentation, as well as the specific procedure to be performed, has been explained to me. I hereby authorize Beauty Realm LLC and its artists to perform upon myself the following procedures (detailed in the next section). lf any unforeseen condition arises in the course of this procedure(s), I authorize the artist to do whatever they deem necessary in that circumstance to achieve the desired result. I understand that I will be informed of any changes to the procedure prior to them being completed. I accept responsibility for approving the color, shape and position of the permanent cosmetic procedure during the course of my consultation. I understand that an allergy test does not guarantee that I will not have an allergic reaction to the pigment. Beauty Realm LLC and its' artists does not accept responsibility if the treatment area does not numb. Each individual is different. I fully understand and accept that non-toxic pigments are used during the procedure and that the cosmetic enhancement achieved may fade over a period of 1-3 years. waiting longer than this for a color boost may result In a higher price. Eyeliner procedures: You will be asked to keep your eyes closed throughout the numbing period. If for some reason the anesthetic gets into the eye, you must advise your technician at once. It is not harmful to the eye although you will experience some stinging and slight discomfort. The cream will be removed, and your eyes will be immediately flushed with a sterile saline solution. It is then safe for the technician to reapply the anesthetic. NOTE: If you experience stinging in the eyes and do not Inform your technician Immediately, the anesthetic may numb the eyeball, and a possible corneal abrasion may occur. This can result in a temporary streaming and light sensitivity of the eyes. You may be unable to open your eyes and each time you blink it may be painful, and temporary blurry vision may occur. Corneal abrasion, however, is rare.
I have been informed that the highest standards of hygiene have been met and that sterile disposable needles and pigment containers are used for each Individual client, procedure and visit. I understand and accept that each procedure is a process requiring multiple applications of pigment to achieve desirable results, and that 100% success cannot be guaranteed during the first procedure. I understand that this is why I Will need to return for a retouch procedure and that my follow up appointment should be made right away. I understand that a retouch procedure will be performed 6-8 weeks after the initial procedure and that after a 3-month period I will be charged an additional fee for any further work. ( I understand that it is my responsibility to book the appointment at a time convenient for both parties. The result of the procedure is determined by the following: Medication, Skin Characteristics - (dry, oily, sun-damaged and thickness), Natural skin undertones - (blending with chosen pigment), Personal pH balance of skin, which changes from visit to visit, Alcohol intake and smoking, adhering to Post Procedure care treatment. Upon completion of the procedure there may be swelling and redness of the skin, which will subside between 1-2 days. In some cases bruising may occur. You may resume normal activities immediately following the procedure however, using cosmetics, excessive perspiration, steamy showers and exposure of the sun to the affected area must be limited. I have been advised that the true color will be seen within 1 month after each procedure, and that the pigment may vary in color according to skin tones, skin type, age and skin conditions. I understand that some skins accept pigment more readily than others and no guarantee to an exact effect or color can be given. LipProcedures: I am aware that the lip procedures may stimulate any dormant virus such as herpes (cold sores). I am informed that eye procedures may stimulate dormant eye disorders or eye infections, and that some medication can prevent absorption of the pigment. I agree to follow all pre-procedure and post-procedure instructions as provided and explained to me by the artist. I confirm that I have received copies of all the relevant aftercare instructions. Being of sound mind and body, I hereby release any and all liability of Beauty Realm LLC and its artists. I accept any and all responsibility for any consequence that might arise from my decision to have any permanent cosmetics procedure performed. For the purpose of documentation, I also consent to the taking of "before· and "after" photographs of said procedure(s) for record purposes and for use in presentation portfolios and social media.
I understand that there are no refunds. I certify that I have read and fully understand the above consent and procedure permit; that thee explanations therein referred to were made and I accept full responsibility for these and or other complications which may arise or result during or following the permanent cosmetic tattoo procedures which is to be performed at my request according to this consent and procedure permit. To my knowledge I do not have any physical, mental. or medical impairment or disability that might affect my well-being as a direct or indirect result of my decision to have the procedure done at this time. I am over 18 years of age. I am not pregnant. I am not under the influence of drugs or alcohol. Signing below confirms I have read and understand the above information and have answered all questions to the best of my ability: Client Signature: Date: April 2, 2026 Hold Harmless Consent I the undersigned and the person mentioned above, hereinafter referred to as CLIENT, have been fully informed by Beauty Realm LLC and its' artists, of possible complications and consequences of the procedure for which I have contracted artist to do. I understand that this procedure is designed to enhance my appearance, and I consent to treatment, which shall be performed by Jacqueline Soto (Artist) within Beauty Realm LLC suites. I further understand that this procedure, using the permanent make-up pigments, is a permanent cosmetic procedure and cannot be removed easily changed as other cosmetics, and agree to hold the artist harmless in the event of any consequence arising out of this procedure/aftercare. I have been advised and fully understand that improper skin care may lead to an infection of the treated area. Artist has given me proper skin care instructions, which l am to follow. I acknowledge that should my skin become infected due to improper skin care, I will hold artist harmless. I acknowledge that permanent makeup that I contracted for is a long lasting and permanent impression of the treated area. Operator has given me proper skin care instructions. I am however fully informed and aware that the work may fade as a result of age, improper skin care, and prolonged exposure to sun, chlorine and/or salt water. Should the work fade, I will not hold the artist harmless in the event such spread or unevenness occur. l am informed and understand that the work will not in any way contribute to nor itself induce a loosening of the skin or hair. l am informed and agree that the artist shall not be liable in the event such condition occur. Client Signature: Date: April 2, 2026
POLICY CONSENT Rescheduling & Cancellations
You are responsible for rescheduling or canceling your appointment via the booking app link sent to you by text. If you are experiencing technical issues, please text Jacky at 719-297-1447. No charges for rescheduling if done 48 hours prior to your appointment time. Children Policy
To fully enjoy your experience, please leave children at home unless they are being serviced. Enjoy your self-care! Consent Forms
After your booking is confirmed, please visit the main page of my website and click the menu bar (top right-hand corner). Select the drop-down menu, proceed to select the consent form for your treatment. Forms must be completed at least 6-8 hours prior to your treatment time. Arrival Instructions
Upon arrival, find Jacky’s doorbell by the reception desk. Please have a seat and wait for your name to be called. You are welcome to use the restrooms within the facility. Conduct Policy
Disrespectful behavior will not be tolerated. You may be dropped as a future client if Jacky feels uncomfortable or unsafe. Tardiness
Appointments are subject to rescheduling and additional fees if you are more than 10 minutes late. Cancellation Fees - Late cancellation (less than 48 hours): 50% of service total
- Same-day rescheduling/cancellation: 50% of service total
- No-show/no-call: 100% of service total
No-shows or no-calls may result in being dropped as a future client. Refunds & Satisfaction Policy
Please note that no refunds will be issued for services rendered. However, your satisfaction is very important to me. If you are dissatisfied with your service, please contact me directly as soon as possible. I will work with you to address your concerns and ensure you are comfortable with your results. I am committed to providing an excellent experience and will make every effort to resolve any issues. Retail Item Policy
All retail sales are final and non-refundable. However, if you are not completely satisfied with your purchase, I am happy to offer an even exchange for another product of equal value. Please contact Jacky within 7 days of purchase to initiate the exchange. Items must be unused, unopened, and in original condition to qualify for an exchange.
Beauty Realm LLC
(719) 297-1447 | 