Tattoo/Microblading: Eyebrows Logo
  • Cosmetic Tattoo Consent Form

    Cosmetic Tattoo Consent Form

    This is a legal document. Please read all information carefully

  • Client Information

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  • EMAIL / NEWSLETTER

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    We will use your email address solely to provide information about our company. Your information will not be sold.

  • MEDICAL QUESTIONNAIRE

    For a more effective, personalised treatment, please be as accurate as possible when filling out the following information.


  • COSMETIC TATTOO PRE-PROCEDURE ADVICE

    PLEASE READ THE FOLLOWING ADVICE CAREFULLY AND SIGN AT THE END

  • Cosmetic tattoo procedures normally require multiple treatment sessions. For the best results, clients will be required to return for at least one re-touch appointment. This will take place 6-8 weeks after the inital procedure. Those with oily skin may require an additional touch up. Please be aware that colour intensity will be significantly darker and sharper immediately and a few days after the inital procedure, but the colour will reduce by 30-50%.

    Although numbing cream is used during the procedure, sensitivity or discomfort may still be felt and skin may be red and/or swollen after the procedure.

    Please do not drink alcohol 24 hours prior to the treatmnet.

    A patch test can be performed, unless waived by the client.

    No electrolysis for at least 5 days before the procedure.

    Botox, AHA products and retinoids should be avoided for 2 weeks prior to the procedure.

    Botox should be avoided for 5 weeks prior to the procedure.

    Exfoliating treatments such as microdermabrasions should not be performed within 2 weeks prior to procedure.

    Chemical and laser peels should be avoided no less than 6 weekks prior to procedure.

    Patients prone to cold sores/fever blisters should take an anti-viral prior to treatment.

    Hormone therapies can affect pigmentation and/or cause sensitivity.

    Cosmetic tattooing is intended to be semi-permanent, lasting an average of 9-18 months. Longevity of the service is different for each individual and is determined by mutliple factors such as but not limited to, skin type, age, health and lifestyle.

    On rare occasions, the pigment may migrate under the skin. Thus becoming permanent.

    The procedure of microblading may be uncomforatble.

    Although extremely rare, there may be an immediate or delayed allergic reaction to the pigment.

    A negative patch test result does not guarantee that you will not develop an allergic reaction after the full procedure.

    Allergic reactions to anesthetic can occur.

    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 are going to have an MRI scan within 3 months after the procedure, you should notify/discuss with your doctor.

    Possible scarring may occur.

    I have read and fully understand all aftercare information as stated on website https://www.thehollowwagga.com.au/pma and agree to adhere to all stated advice.

    I have read and fully understand the information provided above & confirm that all information provided by me is correct and truthful. 

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  • TOPICAL ANESTHETIC ADVICE

    ALLERGIC REACTION: Allergic reaction can occur from any anesthetics used during the procedure. If you do suffer from an allergic reaction, you should contact your doctor immediately. Allergic reaction response may show through redness, swelling, rash, blistering, dryness or any other sympotoms associated with an allergic reaction.

    NUMBNESS: We cannot accept responsibility if the area to be treated does not respond to the numbing cream. Each individual is different and some clients report the area to be completely numb, while others may experience some discomfort.

    I have read and fully understand all of the above information provided and any risks involved with the use of topical anesthetics and I therefore consent to the use of anesthetic for the cosmetic tattooing procedure.

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  • INFORMED CONSENT FOR COSMETIC TATTOOING

  • I * am over the age of 18, am not under the influence of drugs or alcohol, am not pregnant or nursing and desire to receive the indicated semi-permanent pigmentation procedure. The general nature of cosmetic micro-pigmentation, as well as the specific procedure to be performed, has been explained to me.

  • *         If an unforeseen condition arises in the course of the procedure, I authorise my therapist to use her professional judgement to decide what she feels is necessary under the given circumstances. I accept the responsibility for determining the colour, shape and position of the cosmetic tattoo procedure as agreed during consultation. I fully understand and accept that non-toxic pigments are used during the procedure and that the result achieved may fade over a period of 6 months - 3 years. Even once the colour fades, pigment itself may stay in the skin indefinitely.

  • * I understand that the highest standards of hygiene are 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 the desired result, and that 100% success cannot be guaranteed during the first procedure. I understand that I may have to return for a repeat procedure.

  • * I understand that the true colour will be seen 6 weeks after each procedure, and that the pigment may vary according to skin tones, skin type, age and skin condition. I understand that some skin types accept pigment more readily and no guarantee on exact colour can be given.

  • * 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 agree to follow all pre-procedure and post-procedure instructions, and understand that failure to do so may jeopardise my chances for a successful procedure.

  •    *   I understand the permanent skin pigmentation procedure carries with it known and unknown complications and consequences associated with this type of cosmetic procedure, including but not limited to: infection, scarring, inconsistent colour, and spreading, fanning or fading of pigments. I understand that actual colour of the pigment may be modified slightly, due to the tone and colour of my skin.

  • * I fully understand this is a tattoo process and therefore not an exact science but an art. I request the semi-permanent skin pigmentation procedure(s) and accept the permanence of this procedure as well as the possible complications and consequence of the said procedure.

  • There is a possibility of an allergic reaction to numbing agent and/or pigments. A patch test is offered however it does not ensure a client will not have an allergic reaction. If waived, I release the technician from liability if I develop an allergic reaction to the pigment. Initial one or the other, not both:
    I consent to the patch test OR I waive the patch test.

  • * I understand that if I have any skin treatments, injectables, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my cosmetic tattoo procedure. I acknowledge some of these potential adverse changes may not be correctable.

  • * I certify that I have read and initialed the above paragraphs and have had explained to my understanding the consent and procedure permit. I accept full responsibility for the decision to have this cosmetic semi-permanent pigmentation work done.

  • * I understand there is no warranty or guarantee made to me as a result of this procedure and the final result cannot in any way be guaranteed. There are no refunds for this procedure.

  • I release Chelsea Price of all claims and injury, seen or unseen that may occur as a result of this procedure..

  • * As I understand all of the above information I knowingly give Chelsea Price permission to perform my cosmetic tattoo procedure.

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