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Thank you for choosing Pretty Little Face, LLC for your permanent makeup experience. Please make sure that you read the following instructions to assure the best result 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
  • Blood thinning medications
  • Energy Drinks
  • Coffee
  • Tea
  • THC

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

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

  • Vitamin A, C, E
  • Fish Oil
  • Retin A Topical
  • Any active skincare ingredients (AHA, BHA, etc)

All of the products mentioned  above could cause excessive bleeding and will negatively affect the longevity of your semi-permanent makeup application. In some cases, the application may need to be prematurely stopped.



First Client’s Name

First Name*

Last Name*

Phone*
First Client’s Date of Birth*
First Client’s Signature*
Second Client’s Name

First Name*

Last Name*
Second Client’s Date of Birth*
Third Client’s Name

First Name*

Last Name*
Third Client’s Date of Birth*
Fourth Client’s Name

First Name*

Last Name*
Fourth Client’s Date of Birth*
Fifth Client’s Name

First Name*

Last Name*
Fifth Client’s Date of Birth*
Sixth Client’s Name

First Name*

Last Name*
Sixth Client’s Date of Birth*
Seventh Client’s Name

First Name*

Last Name*
Seventh Client’s Date of Birth*
Eighth Client’s Name

First Name*

Last Name*
Eighth Client’s Date of Birth*
Ninth Client’s Name

First Name*

Last Name*
Ninth Client’s Date of Birth*
Tenth Client’s Name

First Name*

Last Name*
Tenth Client’s Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
CONFIDENTIAL MEDICAL PROFILE
1. Do you have previous permanent makeup? *
Yes
No
2. Are you over the age of 18?*
Yes
No
3. Are you pregnant or nursing?*
No
Yes
4. Do you have Epilepsy/Seizures of any kind?*
No
Yes
5. Do you have any Autoimmune Disorders?*
No
Yes
6. Do you currently or have had Cancer? *
No
Yes
7. Are you taking any medication, including immunosuppressives such as anti-inflammatory or steroids?*
No
Yes
8. Do you have Diabetes? *
No
Yes
9. Do you have any problems with healing?*
No
Yes
10. Do you have any heart conditions?*
No
Yes
11. Do you have Hepatitis?*
No
Yes
12. Do you have HIV?*
No
Yes
13. Do you take antidepressants or mood altering medications?*
No
Yes
14. Are you currently using Retin-A or Alpha Hydroxy skin care products?*
No
Yes
15. Do you wear contact lenses?*
No
Yes
16. Do you get fever blisters or cold sores?*
No
Yes
17. Are you allergic to topical antibiotic preparation? (Polysporin, bacitracin, neosporin, Caine family drugs or petroleum based products like Vaseline)*
No
Yes
18. Is there any history of skin disease or remarkable skin sensitives? *
No
Yes
19. Are you presently taking Vitamins A, C,E or fish oil in any form?*
No
Yes
20. Are you required to take antibiotics during dental or invasive medical procedures?*
No
Yes
21. Are you currently on Accutane treatment?*
No
Yes
22. Have you had a chemical or laser peel within the last month?*
No
Yes
23. Do you have Alopecia?*
No
Yes
24. Do you have Keloid or Hypertrophic Scars?*
No
Yes
25. Any tendency to bleed excessively from minor cuts?*
No
Yes
26. Have you had Aspirin or any blood thinning medications/supplements within the last 7 days?*
No
Yes
27. Have you had caffeine products with the last 24 hours?*
No
Yes

If you checked off any medical condition please request a doctors note clarifying clearance for “Permanent Makeup Tattooing or Microblading” and bring to your appointment. We absolutely cannot perform on anyone pregnant or nursing



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I declare that I am over the age of 18, not under the influence of drugs or alcohol, not pregnant or nursing, not on blood thinners or blood pressure medication, and am not an insulin-dependent Diabetic. I understand that many medications and some diseases and disorders may either contraindicate me for treatment or affect the results. I understand I should continue taking my medications, and tell my technician about all prescript and non-prescription drugs, supplements, topically applied products, eye drops, etc. I have been informed of the general nature of permanent makeup and the specific nature of the procedure(s) describe above. *
I Consent
Risks of Procedure(s): I understand there are risks associated with permanent makeup, including, but not limited to: infection: Procedures which involve penetrating the skin could cause infection; Scarring: Recovering from the procedure(s) could lead to scarring; Allergic reaction: Pigments, dyes, or other materials used could cause a reaction; Color: Colors will vary based on skin tone, pigments may fade over time; Irregularity: Pigments may fan or spread, causing makeup lines to blur; Corneal Abrasion: Rubbing or scratching eyes or applying contacts shortly after an eyeliner procedure could cause an abrasion; Permanence: Permanent makeup is intended to produce long-lasting changes to appearance which may be difficult or impossible to modify or remove.
I Consent
Other Treatment: I understand that if I have any skin treatments, including, but not limited to laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my permanent cosmetics. I acknowledge some of these potential adverse changes may not be correctable.
I Consent
Pigment Allergy Patch Test: While an allergy patch test is recommended, it does not always accurately predict whether you will have a reaction. If waived, you release the technician from liability if you then have an allergic reaction to the pigment. *If you consent to a patch test please contact Pretty Little Face, LLC before booking an appointment. A sample of the pigment will be provided to you. You may then schedule an appointment with your doctor to testing. Once you are cleared from from you doctor you may then schedule an appointment. We will need a copy of clearance before scheduling your permanent makeup procedure.
I Consent to a Patch Test
I Waive the Patch Test
Pre-Procedure and Aftercare Instructions: I have received, and will strictly adhere to, all pre-procedure and aftercare instructions. I understand that my failure to do so may jeopardize my chances for a successful procedure. If I am on 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 any strictly follow my doctor’s instructions before contemplating any permanent cosmetic procedure around my lips. I certify that this consent has been fully explained to me, that I have read and understand the above. I consent to my photograph being taken before and after the procedure(s).
I Consent
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 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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