Cosmetic Tattoo Consent Form

Brows and Beyond By Carol / Skin Deep Body Art 313 S. Ridgewood Drive, Sebring FL 33870 - 407.257.4424 Phone - browsandbeyondbycarol@gmail.com The Artist performing this Cosmetic Tattoo is Carol Spears.

Name

First NameLast Name

Address

Street Address

CityState

Zip Code

Date of Birth

Date

Age

Phone Number

Format: (000) 000-0000.

Email

example@example.com

Cosmetic Tattoo Procedure

Please select the procedure for your appointment..

Do you have any known allergies?

If yes, please list.

Are you currently on any medications?

If yes, please list.

Are you currently pregnant or nursing?

Have you had any adverse reactions to topical/secondary numbing agent?

A patch test is available for reactions to pigment. Although advisable, it does not ensure there will be no reaction to pigments. Patch tests must be administered 48 hours prior and results evaluated 24 hours prior to appointment. Please consent or waive the patch test.

Photos are essential to an Artists portfolio and work, typically, Before/After pictures of procedure and procedure area are taken. Please allow or decline photo permission.

My emergency contact name is      Name*   .
My emergency contact phone number is            Phone Number*   .
My preferred physician is      Name*      Phone Number*
My preferred medical facility is   *

PRE-CARE instructions prior to your service - limit alcohol, caffeine, and aspirin at least 24 hours prior to appointment. Do not sunbathe or tan the day prior or day of procedure. Do not exfoliate harshly or cause any irritation the day prior. Clean and moisturize skin, but do not wear makeup to your appointment.

AFTERCARE INSTRUCTIONS - Gently cleanse the tattooed area 3x per day with cleanser provided with your aftercare kit, rinse, and pat dry. For BROWS and EYELINER, allow to air dry until tightness occurs, the apply aftercare (coconut oil or Lubriderm - DO NOT use A&D, Aquaphor, or any other aftercare that has NOT been provided at the time of service. Use a grain of rice amount and no more as it can suffocate the area. DO NOT PICK, RUB, OVERWASH, OR REMOVE ANY FLAKING OR SCABBING PREMATURELY. THIS WILL NEGATIVELY AFFECT YOUR OUTCOME. Allow your body to properly heal. DO NOT EXFOLIATE. Your skin needs to breathe to heal properly. For LIP BLUSH, keep hydrated constantly and apply aftercare provided continuously. You may switch to Aquaphor after 24 hours for lips only. Do not allow your lips to dry out, or become cracked as that will affect the overall outcome of your procedure. FOR ALL PROCEDURES: No sun exposure, tanning, sauna, steam rooms, or pools/oceans, sweating or wearing any makeup for 5-7 days. Do not pick, rub, scrape, exfoliate any tattoo area, especially while healing (and it is recommended no exfoliation after for retention). If you remove flaking/scabbing areas you WILL remove the implanted pigment! If you have questions or concerns not listed on this form (expectations of healing are following) you agree to contact me immediately. If you have an emergency or are recommended by me to contact your preferred physician, you will do so within 24 hours. Failure to follow instructions and changing aftercare products/procedure WILL affect your end results and is your responsibility.

WRITTEN CONSENT FOR COSMETIC TATTOO. I hereby acknowledge that I have been given the full opportunity to ask any and all questions which I might have about the listed cosmetic tattoo procedure and all questions have been answered to my full satisfaction. I specifically acknowledge that I have been informed of the nature, risks, and possible complications with skin micropigmentation (cosmetic tattoo). I am aware of the risks of the procedure, including but not limited to: infection, scarring, keloid, inconsistent color, spreading, migration, fanning, and fading of pigments. Corneal abrasions are a rare side effect for eye cosmetic tattoos, especially if I rub my eyes or insert contacts too soon after an eyeliner procedure. I acknowledge that the selected color may vary/modify due to the color and undertones of my skin throughout healing. I fully understand that the cosmetic tattoo procedure is not an exact science, but an art. I also acknowledge all attempts will be made for symmetry and a balanced, finished look, and also acknowledge that perfect symmetry is not always possible due to my anatomy, muscles, and facial structures. I {aPatch} to the patch test for micropigmentation. My artist is hereby released from any and all claims if I develop a reaction and agree to attain medical attention. I understand that if I have an inflammatory response, reaction, future skin treatments including laser, fillers, cosmetic surgery, it may have adverse changes to my cosmetic tattoo. I, {name} have read and checked the Pre and Post care of my procedure, risks, complications, and agree to adhere to them to gain the best possible result and give consent to release Brows and Beyond by Carol/Skin Deep Body Art from any and all claims, damages, or legal/medical actions in connection with the requested {cosmeticProcedure} tattoo. I, {name}, {apic} the artists use of my photos for a professional portfolio, social media posts, and advertising.

Signature for Written Consent for Cosmetic Tattoo

EXPECTATIONS DURING HEALING - This section following is to advise you of what may/may not occur during your healing so that you are prepared for the potential outcomes and variables during your healing. Your second session (if applicable - color boost and annual touchups are ONE session only) is scheduled during your initial appointment and cannot fall before or after 4-6 weeks. If you miss your required touch up scheduled, it will be considered a new procedure and fees apply. Annual touch ups are recommended at 12-18 months at a maximum. You may need a color boost prior to that time depending on life style, healing, and exposure. Color Boosts are not considered an annual touch up. Touch ups outside of the 12-18 months are considered a new procedure at the artist's discretion.

Healing varies from client to client. Every effort is made to select the end result color is within the range requested. My procedure is a layering technique and may render lighter results upon the initial application. I understand that my selected initial procedure is a 2 step process and results will vary during this 4-6 week timeframe between processes. Annual touch ups are recommended and are a one time process, however the healing, color retention, and result is not guaranteed.

I understand that after my initial session, and during the healing process, my tattoo color may possibly change, fade, look lighter or darker, or not fully retain. Adjustments to compensate for healing and layer color etc are made at the required touch up. Annual touch ups are recommended to maintain and are a separate fee.

In rare instances, an additional session (within 30 days of final session) may be required to achieve optimal end results. In the event this is required, a supply/service fee of half the Annual Touch Up fee may be required. This is, again, a rare occurrence.

I understand that I am given an aftercare kit and agree to follow for the best result. Swapping cleanser, oils, or ointments without consulting the artist may impede healing or cause pigment removal. Additional sessions may be required at an additional fee if I choose to not follow my artist's advice.

Signature for Expectations of Procedure

Date