PMU/SPMU Appointment Form

PERMANENT MAKEUP/SEMI-PERMANENT MAKEUP CONSENT

Fill the form below and we will get back soon to confirm your reservation appointment. 50% "BOOKING FEE" WILL HOLD YOUR APPOINTMENT and it will be credited towards the service cost. "BOOKING FEE" ARE NON-REFUNDABLE. (Please read Cancellation Policy before booking).
Full Name
Gender
Phone Number

Area CodePhone Number
Date of Birth

DayMonthYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail Address
example@example.com
Where did you hear about us?
Occupation (Required):
PLEASE READ CAREFULLY AND ANSWER EACH SECTION
Have you received chemotherapy or radiation in the past year?
List any medications you have been taking in the past 6 months: (Required):
Check any of the following allergies that apply (Required):
Check any of the following health conditions that apply to you: (Required):
CHOOSE YOUR DREAM BROWS:
Desired Appointment date: 50% "BOOKING FEE" WILL HOLD YOUR APPOINTMENT and it will be credited towards the service cost. "BOOKING FEE" ARE NON-REFUNDABLE. (Please read Cancellation Policy before booking).
Please read the following statement carefully:
- Permanent cosmetics or Removal cannot be performed to pregnant women or nursing mothers. Permanent cosmetics or Removal cannot be applied to any person under the age of 18.
- There is no way to advise on how many tattoo removal sessions you will need.
- Infections can occur if after instructions are not followed correctly.
- There mey be swelling and redness following the procedure. You may experience minor bleeding during procedure.
- Scarring is extremely rare, but may occur.
- The pigments will fade, depending upon your skin cycle.
- After your session, your treated area may appear darker then faded over the healing time.
- You must wait a minimum of 8 weeks before having your next removal session or pmu session.
I understand and have had explained to me proper home care treatment for my procedure. I understand that these procedures may produce some swelling, redness, itching, discomfort, numbness and adverse side effect.

* I understand that the treatment i have chosen is for cosmetic purposes only and NO GUARANTEES have been made to me concerning the results of the procedure.

* I understand that the results achieved and number of treatments required will differ from person to person.

I can confirm that all the information provided by me, is correct and truthful.

I understand that there are no refunds for cosmetic procedures.
Client Signature (required):
Client Printed Name (required):
I have been informed that highest standards of hygiene are met and that sterile, disponsable 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 pigments to achieve desired results, and that 100% success cannot be guaranteed during the first procedure. I understand that i may have to return for a repeated procedure.

Please type your name initials below:
MEDIA RELEASE CONSENT: For the purpose of documentation, advertising, record and use in portafolio, I CONSENT to the taking of "before" and "after" photographs of my procedure.
Client Signature (required):
I certify that i have read and fully understand the above consent and procedure permit; that the explanations therein referred to were made and accept full responsability for these and or other complications, which may arise or result during or following the PMU/SPMU procedure. The treatment is performed at my request according to this consent, pre-procedure form and post procedure guidelines. All services rendered at Shalom Ink are NON-REFUNDABLE. I hereby authorize Shalom Ink Techncian, to perform PMU/SPMU procedure on me.
Client Signature (required):
Client Printed Name (required):
Please read the following statement carefully regarding healing process.

The healing process requires commitment from the client to follow healing protocols and stay away from regiments that could interfere with obtaining the desired appearance.
- I understand that to achieve the best result i must be willing to follow the healing guidelines given to me below.
- Touch up session for tattoo removal should be scheduled 8 weeks from the first session.
- I understand that touch ups will not be scheduled within the 8 week required healing time.
- I understand that i may, experience scabbing, flaking, and changes in color during the healing time. This is the normal part of the healing process and I should not try to pick scabs or cover up with personal regiment.
- I understand that applying makeup to treated area will cause the healed result to be less than desirable.
- I understand that if I decide to have a facial, laser treatment or any other spa related services immediately after or during the healing process, the results may not be best.
- I understand that if I go out into the sun, pool and/or beach that there will be a significant amount of fading.
I understand all that I have read all of the above and commit to abide by the instructions given to me by Shalom Ink. (Signature required):
Date (required):
Please type your name initials below:
IF YOU HAVE PRIOR WORK, PLEASE SUBMIT PICTURE BEFORE BOOKING

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PERMANENT MAKEUP/SEMI-PERMANENT MAKEUP CONSENT

PLEASE READ CAREFULLY AND ANSWER EACH SECTION