• Permanent Makeup Informed Consent

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  • The nature and method of the proposed permanent cosmetics procedure has been explained to me as having the usual risks inherent in the procedure and the possibility of complications during and following its performance.  I understand that there may be a certain amount of discomfort or pain associated with the procedure and that other possible adverse side effects may include: minor and temporary bleeding, bruising, redness or other discoloration and/or swelling.  Fever blisters may occur on the lips following lip procedures in individuals prone to this problem. Fading or loss of pigment may occur. Secondary infection in the area of the procedure is rare if properly cared for, but may occasionally occur.


    By signing below, I specifically acknowledge that I have been advised of the facts and matters set below, and I agree as follows:

     

    (Please mark YES after you clearly understand each statement)

  • Confidential Medical ProfileTo Avoid Unforeseen Complications, Please Answer The Following Questions

  • By signing below, I acknowledge, understand and agree that: 

    The staff at The Archery do not practice medicine, does not accept health insurance, and have made no representation to the contrary.
    The information provided on this form is accurate and complete to the best of my knowledge, and that The Archery is not responsible for complications or problems arising from any incorrect or omitted information; 
    Some individuals will have complications related to permanent cosmetics. These complications are usually mild and last only a few days. However, extreme complications are always a possibility. I accept these risks and agree to hold The Archery and its employees and contractors harmless for same; 
    The staff at The Archery will use the information provided above to assess my suitability for the proposed permanent cosmetics services.

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