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REMOVAL

Thank you for choosing Pink Sol Beauty for your PMU Removal experience. Please make sure that you read the following instructions to assure the best results for your procedure.

24 hours prior to your appointment it is very important to refrain from the following:

● Alcohol

● Aspirin, or any aspirin products

● Ibuprofen

● Aleve

● Energy drinks

● Coffee

Not having caffeine in your system will help you to relax, as well as, to help relax the facial muscles where we will be working.

7 days prior to your application, please refrain from using the following:

● Vitamin E

● Fish Oil

● Retin A topic



First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Parent or Guardian's Driver's License / ID Card
Driver's License / ID Card Number*
Issuing State*
To avoid unforeseen complications, please answer Y (yes) or N (no) to the following questions
Do you have previous Permanent Make Up?*
No
Yes
Are you over the age of 18? *
No
Yes
Have you had Botox or injectables less than 2 month?*
No
Yes
Are you pregnant or nursing?*
No
Yes
Do you have Epilepsy/ Seizures of any kind?*
No
Yes
Do you have any Autoimmune Disorders?*
No
Yes
Do you currently or have you had Cancer? *
No
Yes
Do you have HIV?*
No
Yes
Have you had chemical or laser peel less than 30 days?*
No
Yes
Have you had Aspirin or any blood thinning medications/supplements within the last 7 days?*
No
Yes
Do you have any problems with healing?*
No
Yes
Do you take Antidepressants or mood altering medication?*
No
Yes
Do you get fever blisters or cold sores?*
No
Yes
Are you currently undergoing radiation or chemotherapy?*
No
Yes
Are you currently using Retin-A or Alpha Hydroxyl skin care products?*
No
Yes
Do you wear contact lenses?*
No
Yes
Have you had caffeine products in the last 24 hours?*
No
Yes
Are you taking any medication, including immunosuppressive, such as anti-inflammatory or steroids?*
No
Yes
Are you allergic to topical antibiotic preparation? e.g. Polysporin, Bacitracin, Neosporin, or Caine family of drugs or Petroleum based products (Vaseline)?*
No
Yes
Are you presently taking Vitamins A, E or fish oil in any form?*
No
Yes
Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
Do you have any heart conditions?*
No
Yes
Do you have Alopecia?*
No
Yes
Are you currently on Accutane Treatment*
No
Yes
Do you have Keloid or Hypertrophy Scars?*
No
Yes
Do you have Hepatitis?*
No
Yes
Do you have Diabetes?*
No
Yes
Any tendency to bleed excessively from minor cuts?*
No
Yes
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*
Middle Name
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
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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