The nature and method of the proposed pigment (tattoo) lightening procedure has been explained to me including risks or possibility of complications during or following its performance. I understand there may be a certain amount of discomfort or pain associated with the procedure and that the other adverse side effects may include: minor and temporary bleeding, bruising, redness or other discoloration and swelling. Fever blisters/cold sores may occur on the lips following lip procedures in individuals prone to this problem. Secondary infection in the area of the procedure may occur, however, if properly cared for, this is rare.
I understand that several treatments may be needed in order to attempt to achieve my desired results. However, I have not received any guarantees to the quality of the process.
I understand there are medical options available for pigment (tattoo) removal I have decided to decline those methods and proceed with this procedure.
I understand that the unwanted pigment may not be successfully lightened to the point that it can no longer be seen. Scarring, hyperpigmentation or hypopigmentation, or other damage to the skin may occur during this process and may be permanent. This is rare but it can happen. I will not hold technician, the studio (location and its owner) and/or the distributor/manufacturer of tattoo removal products used in this attempted pigment (tattoo) lightening or removal liable for any damages that may occur to my person.
I understand there will be no refunds if the desired lightening result is not achieved.
*For skin types V and VI: I understand that I am at a higher risk for hyperpigmentation and hypopigmentation than other skin types. I agree to the risk involved.
I understand that lightening tattoo pigment is difficult, if even possible. As a result, I will not hold my technician or the studio responsible for any resultant failure to lighten the unwanted pigment.
I agree to submit to before and after photographs, and give my permission to use such photographs for publication, marketing and/or teaching purposes.
I agree to follow all aftercare instructions provided by me by my technician.
I have been duty informed of the natures, risks, possible complications and consequences as listed above. I further understand that my technician is not a medical doctor.
There is a fee for this service and additional fees for all additional sessions. The fee's have been explained to me and I agree to the fees. Fees for the additional session(s) cannot be determined until the results from this first session are complete and how much needs to be done the additional session(s) can be determined.
I have disclosed all that has been asked of me to the best of my ability and I understand all information listed above. I have had all my questions answered, and agree to all conditions and provisions of this document as evidenced by signature below. I accept the risks for having this procedure done, therefore, I release my technician and the studio from any and all liability.
COVID-19:
I understand that I am opting for a service that is not urgent and not medically necessary.
I also understand that the coronavirus disease (COVID-19) has been declared a worldwide pandemic by the World Health Organization. I further understand COVID-19 is extremely contagious. State and federal health agencies recommend social distancing. I recognize that the staff at Lorena Soto Makeup LLC are closely monitoring this situation and have put in place reasonable preventive measures targeted to reduce the spread of this virus. However, given the nature of the virus, I understand there is an inherent risk of becoming infected with COVID-19 if I proceed with this elective service.
Accordingly I acknowledge and assume the risk of becoming infected with COVID-19, and any variation or mutation thereof, through this elective service and I gave my express permission to proceed with the same. This consent applies to any follow up or additional services in the upcoming months. I understand that even if I have been tested for COVID-19 and received a negative test result, the tests may not have detected the virus or I may have contracted COVID-19 after the test. I will not hold this business and professional offering the service responsible for any liability related to COVID-19 and any variation or mutation thereof.
I understand that exposure to COVID-19 before, during, or after my procedure(s) may result in complications and/or delayed healing. I have been given the option to defer my service to a later date. However, I understand all the risks including those noted herein and I would like to proceed with this service. I understand the explanation and consent to the procedure.
Furthermore, I have been informed of the nature, risks, and possible complications and on sequences of permanent skin pigmentation. 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, allergic reaction, scarring, inconsistent color, pigment migration, fanning or fading of pigments. I understand that all pigments and inks are not FDA-approved and that the actual color of the pigment may be modified slightly, due to the tone and color of my skin. I fully understand that this is a tattoo process and therefore not an exact science, but an art. I request the permanent skin pigmentation procedure(s), and fully accept the possible permanence of the procedure as well as any possible complications and consequences of the said procedure(s).
I understand that COVID-19 may cause additional risks, some or many of which may not currently be known at this time, in addition to the risks described herein, as well as those risks for the service itself. I have been given the option to defer my service to a later date. However, I understand all the potential risks, including but not limited to the potential short-term or long-term complications related to COVID-19, and I would like to proceed with my desired services.