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  • Client's information

    PLEASE ENTER VALID INFORMATION BELOW
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  • The procedure chosen by the client

    PLEASE READ CAREFULLY AND SELECT REQUIRED PROCEDURE

  • The Client hereby confirms that he/she wants to have:

    • the long-term (permanent) makeup procedure
      OR
    • the long-term (permanent) makeup removal procedure 

    made to him/her: the injection of a special colour (pigment) in the skin in the facial area to intensify the shape of eyebrows, eyes, or lips or to remove enhancement of the shape of eyebrows, eyes, or lips or a tattoo in accordance with the procedure adopted by the authorized institution (a hygienic standard or etc.) in the country in which the procedure is performed.

  • To perform the procedure chosen by the Client safely, the Client hereby is submitting information by checking boxes by “x” respectively. If the Client deems it necessary, he/she indicates additional information on supplementary pages, which is that the Client indicates diseases he/she has or/and medicines he/she administers.

  • Disease or the medicine administered as of the date of filling in this consent form.
    Check YES if medicine administered. Check NO if medicine not administered.

    • HEALTH & SAFETY QUESTIONNAIRE(click to expand) 
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    • Confirmations of the Client

      The Client hereby is confirming that:
      1. Before signing this consent form, the Specialist informed the Client of the background of the procedure methodology, the nature of the procedure, its goal and necessity, expected results of the procedure, the progress of the procedure, the number and frequency of procedures, the risks and possible complications related to the procedure, the further treatment of facial areas injured during the procedure and the measures to be applied, the injections and other material applied during the procedure, answered all the Client’s questions, and on request of the Client explained all the aspects of the procedure which the Client worried about. The Client has read the protocol / standard for the performance of the procedure;
      2. Before signing this consent form, a master-executor of the procedure inquired the Client of possible problems or diseases that are inadvisable for the performance of the procedure. The Client does not have haemophilia, diabetes mellitus, hepatitis, HIV and/or any other infectious diseases, is not pregnant, and understands that the procedure will not be performed if any aforesaid problem exists. The Client does not administer any medication for blood thinning (anticoagulants) (aspirin, Hjertemagnylis, orpharin, regularly administered anti-inflammatory medicines);
      3. Prior to signing this consent form, the Client informed the Specialist of diseases he/she has undergone and the medicines administered by him/her so that the Specialist could evaluate the possibility of performance of the procedure;
      4. The Client, 24 hours before the performance of the procedure, did not consume alcohol, addictive substances, and stimulators, and the Client is informed that he/she is not advised to consume such substances for 24 hours after the performance of the procedure;
      5.  The Client understands that during the procedure he/she will experience a lower or higher pain that could be reduced by cryoanaesthesia or local anaesthesia applied by special cream (except in cases when a person is sensitive to an anaesthetic medicine);
      6. The Client understands that during and/or after the procedure swelling, increase in blood pressure, redness, pain feeling, an irritation, itching, dryness in a facial area where the procedure is / was performed, an allergic reaction, or crusts may occur and that these consequences will gradually varnish. The Client has been instructed how to behave after the procedure, has been informed of the period of time during which side effects should disappear and how to match the procedure and other cosmetic procedures and products;
      7. The Client understands that during and/or after the procedure the change of colour or a colour rejection reaction may occur in very rare cases, and the Client understands that, due to individual features of each human body, the Client cannot be provided with one hundred percent guarantee for the results of the procedure. For first 7 days after the procedure (in case of performance of a permanent makeup), the facial area that has been exposed to the procedure will be approx. by 40% brighter / darker and approx. By 10–15% thicker. Colour acceptance/rejection and, respectively, the result of the procedure depends on the individual skin structure and a skin pigment as well as on skin absorption features. Therefore in some cases, it may become necessary to repeat the procedure several times until the desired result is achieved. The first correction is performed 4–5 weeks after the procedure. The Client who has greasy facial skin may require more corrections. Neither minimal nor maximal time limit for achieving the result of the procedure can be fixed, therefore the Specialist/the Institution does not provide any guarantee;
      8. The Client understands that during the procedure the shapes of the object (eyebrows, lips, and etc.) are determined according to the facial proportions, while asymmetry is determined digitally, with closed eyes to avoid the negative impact of a facial expression;
      9. The Client understands that the procedure has a very uncommon in the medical practice risk of being infected with viral, bacterial, fungal diseases, infections, the injure of blood vessels and nerves, allergic reactions, scars, and recurrence of diseases the Client is ill with;
      10. The Client understands that the procedure causes the injure of his/her skin, therefore the due after-procedure skin treatment is required to secure that the skin is healed without complications. The undue skin treatment may cause undue results of the procedure, and the Specialist/the Institution does not assume any liability for such results;
      11. The Client has absolute rights by himself/herself to decide to order and perform the procedure, and none consents of other persons for the performance of the procedure are required. The Client ordered the performance of the procedure of his/her own will and after evaluating all circumstances;
      12. Prior to signing this consent form, the Client looked through the wording of this consent form, had a possibility to discuss it with the persons selected by the Client, to ponder over and evaluate it, the Client understood the wording and goal of the document and agrees with all the provisions thereof. The Client gives his/her consent to the performance of the procedure and certifies this by affixing his/her signature to this document. The Client understands that, if any questions arise, he/she should contact the Specialist.
      13. This document is also deemed to be a service provision card. This document has been executed in three counterparts, one counterpart to the Client and to the Specialist and the Institution.
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