____ Aftercare instructions have been explained to me and a written copy will be given to me to retain in my possession, which I will follow to the best of my ability.
____ I understand that a certain amount of discomfort is associated with this procedure and that swelling, redness and bruising may occur.
____ I understand that Retin A, Renova, Alpha Hydroxy, and Glycolic Acids must not be used on the treated areas. They will alter the color.
____ I understand that sun, tanning beds, pools, some skin care products and medications can affect my permanent makeup.
____ I will tell all skin care professionals or medical personnel about my permanent makeup procedures, especially if I’m scheduled for an MRI.
____ I accept the responsibility for explaining to you my desire for specific colors, shape, and position for any procedure done today.
____ I understand that implanted pigment color can slightly change or fade over time due to circumstances beyond your control and I will need to maintain the color with future applications and a touch up session within 6-8 weeks of initial procedure.
____ I acknowledge that the proposed procedure(s) involve risks inherent in the procedure and have possibilities of complications during and/or following the procedures such as: infection, misplaced pigment, poor color retention and hyper-pigmentation.
____ I have been quoted the cost of today’s appointment which includes one (1) follow up/touch up after 45 days and within 60 days. After 60 days a fee will apply.
____ There will be no refunds for this elective procedure(s).
I certify that I have read or have had read to me the contents of this form. I understand the risks and alternatives involved in this procedure(s) and I have had the opportunity to ask questions and all of my questions have been answered. I acknowledge that I have reviewed and approved the material given to me and I authorized CRYSTAL DELOATCH, as my technician to perform on my body the Microblading/shading procedure desire today.