PMU Permission Form

Please read the following information carefully and inform the tattoo artist if you have any doubts about your eligibility to be tattooed.

Tattooing and the healing process can come with risks and potential complications as explained to you. You will be given instructions on aftercare to help you minimize the effects.

It is normal for tattooing to be accompanied by pain, redness and swelling. If these symptoms worsen during the healing process, it could be a sign of an infection and you should see a doctor.

Some complications may be related to your health situation. It is important for your safety that the tattoo artist is informed of this. Additional precautions may be necessary.

Tattoos are permanent and, depending on the ink used, they may not be able to be removed properly.

If in doubt, treatment should be delayed and medical advice should be sought.

Do not get a tattoo:

if you are pregnant or breastfeeding;
if you are under the influence of alcohol or drugs;
on a mole or a scar left over from melanoma removal.
The following conditions or conditions may put you at a higher risk of complications:

1) Skin:

a) skin infection regardless of location and type of infection;
b) allergies (please indicate if you have an allergy, for example latex allergy, allergy to metals and preservatives);
c) areas of skin that appear damaged or abnormal, including moles;
d) any active skin diseases (e.g. eczema, psoriasis);
e) skin areas that have been subjected to plastic surgery or radiotherapy including recent scars and keloids (according to medical advice);
f) a previously tattooed spot that has not completely healed;
g) a place where a tattoo has recently been lasered off or removed by another method if the wound has not yet healed.

2) General Disorders:

a) haemophilia or any other coagulation disorder;
b) epilepsy, cardiovascular disease;
c) known allergies (see in F.2, 1), e.g. latex allergy);
d) diabetes;
e) an autoimmune disease;
f) immunosuppression and immune compromised disorders;
g) sarcoidosis.

If any of the above conditions or conditions apply to you and you still want a tattoo, please consult your doctor first and seek advice.

Name of tattoo artist: Kim Loy

Company name and address: Kim Loy Studios, The Color Keizersgracht, Amsterdam. ⁩⁦Keizersgracht 500, 1017 EH Amsterdam⁩

Client Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Date of birth*

Agrees to the following:*

I have been informed about the risks of infections and other complications as a result of permanent make-up.I have received written instructions about the aftercare of my PMU.I find myself healthy enough to have this permanent make-up applied.I acknowledge it is not reasonably possible for the associates, agents and representatives of Kim Loy Studios to determine whether I might have an allergic reaction to the pigments, topical anaesthetic or processes used in my tattoo and I agree to accept that such risks are possible.I give permission for my before and after photos to be used for marketing on Kim Loy Studios social channels and website.

"I confirm that I have given the above information and statements to the best of my knowledge and belief and that they are correct; that I am of legal age to consent to this treatment; that I am not currently under the influence of alcohol or drugs or of other substances that can affect my perception, free will and judgment."

" I authorize the tattooing as described to be performed by the named tattoo artist."

"I have considered the attachment to this consent form."

"I confirm that the tattoo artist may keep this consent form on file."

"I am aware of and accept the risks and potential complications associated with getting a tattoo."

Signature*

Date*

Date