PERMANENT MAKEUP CONSENT FORMS

Permanent Makeup Procedure Consent Form

Name

Date of Birth

Date

Address

Street Address Line 2

City

State

Zip

Cell Phone

Format: (000) 000-0000.

Emergency Contact Phone

Format: (000) 000-0000.

Email

example@example.com

Referred by

I acknowledge by signing this release that I have been given the full opportunity to ask any and all questions which I might have been obtaining permanent makeup from Megan Ramos hereafter “technician” and that all my questions have been answered to my full and total satisfaction. I specifically acknowledge that I have been advised of the matters set forth below and agree as follows:

Initials at each line:

I acknowledge that obtaining permanent makeup is my choice alone. The application of permanent make-up will result in a permanent change to my appearance, and that needles and inks will go into my skin. No representations have been made to me as to the ability to later restore the skin involved in permanent make-up to the original condition, and it is very costly to remove.

I am not pregnant or nursing. I do not have any history of herpes infection at the proposed procedure site. I do not have epilepsy, diabetes, allergic reaction to latex or antibiotics, hemophilia, or other bleeding disorder. I do not have cardiac valve disease or suffer from any heart conditions or take medications that thin the blood.

If I suffer from hepatitis, or other risk factors for bloodborne pathogen exposure, or any other communicable disease, I have informed the technician of the fact that have been advised of any medications and procedures necessary to promote the satisfactory healing of my tattoo.

I do not suffer from any medical or skin condition such as, but not limited to: keloid or hypertrophic scarring, psoriasis at the site of the permanent make-up, or any open wounds or lesions at the site of the tattoo.

I have advised the technician of any allergies to latex gloves, soaps, or medications. I acknowledge it is not reasonably possible for the technician to determine whether I might have an allergic reaction to the permanent make-up process and further acknowledge that such a reaction is possible.

I do not have a history of medication use or currently using a medication, including being prescribed antibiotics prior to dental or surgical procedures.

I have truthfully represented to the technician that I am 18 years of age or older. I am not under the influence of any drugs or alcohol. To my knowledge, I do not have any physical, mental, or medical impairment or disability that might affect my well-being as a direct or indirect result of my decision to have a tattoo at this time.

I acknowledge infection is always possible as a result of permanent make-up application, and I agree to follow all suggested instructions concerning the care of a permanent make-up site while it is healing.

I acknowledge and give consent to this permanent make-up studio to use images of my tattoo for marketing and, or publishing purposes in various media such as the internet, magazine, printed, and or television etc.

I understand I will have permanent make-up applied using appropriate instruments and sterilization techniques. I understand that the permanent make-up site usually takes 2 weeks or longer to heal. I agree to release and forever discharge, and hold harmless, the technician, all employees, contractors, and the management of the permanent make-up studio from any and all claims of negligence, damages, or legal actions arising from or connected in any way with my tattoo, the procedure, and conduct used in my tattoo and assume all responsibility for the decision made consenting to this permanent procedure.

Signature

Micro-pigmentation is the process of placing pigment into the dermis. This process is considered a tattoo. These pigments can last a few years or indefinitely, depending on skin tone and the intensity of the color that is used. Lighter skin tones will not hold the color as long as darker skin tones and may require an occasional touch-up to prolong the results of the procedure.

The following may occur after your procedure:

Discomfort/Swelling: discomfort is usually mild and can be controlled with over-the-counter ibuprofen.
Bruising: bruising is rare, but if it does occur, it is mild and will resolve within a few days.
Pigment Intensity: immediately following the procedure, the pigment will appear dark/vibrant. The color will fade within 7 to10 days, and settle into the final color.
Color: Efforts will be made to achieve the exact color desired, but an exact match cannot be guaranteed due to different undertones in the skin and pigments being used.
Pigment irregularity: the pigment may heal inconsistently, with some areas healing lighter/darker than others. There may be possible fading and fanning/spreading, or pigment migration. This is normal and cannot be anticipated. The touch-up procedure will correct this.
Infection: This is very rare, but can occur if the treated area is not kept clean and protected with the recommended ointment.
Herpetic Breakout: this can occur with lip procedures if someone is prone to cold sores. An anti-viral must be taken four days prior to the procedure and for four days following the procedure for prevention.

Allergies: Please list any allergies that you may have had before moving forward with the procedure. If there are none, please complete and sign below.

I have consent that I do not have any known allergies and confirm to continue with the procedure.

Signature

Date Signed

Pre Cautionary Corona Virus Liability Release Form

Due to the 2019-2020 Global Pandemic Outbreak of the Novel Coronavirus, Covid-19, we are taking extra precautions with the intake of each client, health history review, as well as sanitation and disinfecting practices. Please complete the following below.

Symptoms of Covid-19 includes:

Fever
Chills
Fatigue
Muscle Pain
Headache
Sore throat
Dry cough
New loss of taste or smell

Type YES to affirm

I understand the above symptoms and affirm that I and any household members do not have nor experienced the above symptoms within 14 days.

I affirm that I, as well as all household members, have not traveled internationally within 14 days.

I affirm that I, as well as all household members, have not traveled to a highly impacted or "hot spots" in the last 14 days.

I affirm that I, as well as all household members, have not been exposed to someone suspected and/or confirmed case of the coronavirus/COVID 19.

I affirm that I, as well as all household members, have not been diagnosed with coronavirus/COVID 19 within the last 30 days.

I am following all CDC recommended guidelines as much as possible and limiting my to the Coronavirus/Covid 19.

I acknowledge the contagious nature of the Coronavirus/Covid 19 and that the CDC and other public health authorities still recommend practicing social distancing. I further acknowledge that Brows by Megan Ramos has put in place preventative measures to reduce spread of the Coronavirus/COVID 19.

I further acknowledge that Brows by Megan Ramos and my permanent makeup artist can not guarantee that I will not become infected with the Coronavirus/Covid 19 I the risk of becoming exposed to and/or infected by the Coronavirus/COVID 19 may from the actions, omissions, or negligence of myself and others, including, but not limited studio's staff of Brows by Megan, and other clients and their families.

I voluntarily seek services provided by Brows by Megan and acknowledge that I am my risk to exposure to the Coronavirus/Covid 19.

I acknowledge that I must comply with all set procedures to reduce the spread while my appointment.

By signing this agreement, I acknowledge the contagious nature of covid 19 and assume the risk I may be exposed to or infected by Covid 19 that such exposure may result in personal injury, illness, permanent disability, and death.

I understand that the risk of becoming exposed to or infected by COVID 19 during my by any employee or staff member in our studio may result from the actions, omissions, negligence of myself and others, including, but not limited to, club employees, volunteers, program participants and their families.

I hereby release and agree to hold Brows by Megan and my permanent makeup artist harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands and damages, costs, expenses, expenses, and compensation for damage or loss to myself and/or property that may by any act or failure to act of the salon, or that may otherwise arise in any way in with any services received from Brows By Megan and my permanent makeup

I understand that this release discharges Brows by Megan and my permanent makeup provider from any liability or claim that I, my heirs, or any personal representatives may against the salon with respect to any bodily injury, illness, death, medical treatment, or damage that may arise from, or in connection to, any services received from Brows and my permanent makeup artist provider This liability waiver and release extends to together with all owners, partners, and employees.

Print Name

Signature

Time & Date of Arrival

Date

Customer Shape Variation Form

I approve the shape that I have picked out for my own brows. This shape is not a usual shape by Browsbymegann or one that has been designed by my artist. My signature will serve as an agreement that the shape can't be changed at a later date and is a permanent tattoo.

Signature

Date

BROWS BY MEGAN

Please be aware that the permanent makeup is a 2 step procedure, the initial procedure and the following touch-up are in between 5 weeks to 3 months. Failure to come back before the 3 months mark, there will be an additional charge depending on time expansion. We can adjust the color and shape upon your arrival for your touch-up appointment.

Permanent makeup is NOT recommended for any clients who are or have:

Chemotherapy (consult your doctor)

Viral infections and/or major diseases

Pacemaker or major heart problems

Skin irritations or Psoriasis near the treated area (rashes, sunburn, acne, etc)

Sick(cold, flu, etc.)

Botox in the past few months

BEFORE CARE:

Do not work out the day of the procedure.
Do not tar or have a sunburned face.
Do not take Aspirin, Niacin, Vitamin E, FIsh Oil, or Ibuprofen 24 hours before the procedure.
No alcohol or caffeine 24 hours before the procedure.
No waxing or tinting 3 days before the procedure.
No tweezing or waxing at least 48 hours before procedure; electrolysis no less than 5 days before.

AFTER CARE:

No water, cleansers, creams, makeup or any other products on treated area for 2 days, un;ess given by your technician.
3-4 hours after your procedure, clean your eyebrows with sterile water (cooled down boiled water) using the cotton squares that were provided in your after care kit wiping off any ointments or lymph fluids.
Do not rub, pick, or scratch the treated area. Let any scabbing or dry skin naturally exfoliate off. Picking your scabs can cause scarring.
Avoid direct sun exposure or tanning for 3-4 weeks after the procedure.
Avoid heavy sweating for the first 10 days.
No facials, botox, chemical treatments/peels, and microdermabrasion for atleast 4 weeks.

LONG TERM CARE:

Use a good sunscreen after 10 days, un exposure will fade your permanent cosmetics. If you are planning a chemical peel, laser procedure or an MRI scan, please inform the technician or your care provider of your permanent cosmetics. The use of Retina/Tretinoin, chemical peels, and acid peels or any other rapid skin exfoliation products used on the forehead area will cause the permanent makeup of the eyebrow area to fade prematurely.

Please be aware that the result of the procedure is depending on the following: Medication and health conditions, skin conditions- i.e. oily and poor skin, very dry/flaky skin, sun-damaged skin, loose or laxed skin, natural skin undertones, alcohol intake and smoking, general stress, weak immune system, poor diet, and not following the aftercare instructions may affect your healed results. Antacids, thyroid and anxiety medications have been reported as interfering with permanent makeup either by affecting retention or shifting the pigment to an undesirable tone. Remember, everything we eat and drink has his/her own chemical structure and the electron ends that are unattached or free, may get attached to other compounds inside the body forming a new molecule that may show a different color spectrum. With that info, an educated client may have better expectations and know that he/she may need more frequent adjustments than others. The better condition your skin is in, the better the final results will be. Mature clients may need an additional 1 to 2 weeks healing for the final results to appear. The better you take care of your skin and protect it from UV rays, the better the outcome and lifespan of the permanent cosmetic procedures.

APPROXIMATE DAILY HEALING SCHEDULE FOR PERMANENT COSMETICS

1-2 Days - Your brows are approximately 20-40% darker, bolder, and more solid than your healed result. Under the pigment the skin is red and pigment has been deposited into the layer of skin containing dead skin cells; combined giving the appearance of darker color. There may be minimal swelling but because typically the eyebrow area does not retain much fluid, swelling will be limited. The top layers of the skin will begin to shed in about 5-7 days, and you will see the loss of color. This is normal. Do not scratch/pick!

3-4 Days - Your eyebrows may begin to itch and the pigment may appear somewhat raised or lifted. Do not scratch/pick! 5-7 Days - The skin is now rapidly exfoliating and will shed evenly if left alone. The color under the exfoliating skin will start to appear very light and day by day it will start to appear darker. Please be patient and give the color a couple of weeks to develop back. 30-40 Days - Now is the time to critique your brows, the tattoo has now become parts of the dermis, seen under the epidermis.

I HAVE READ AND UNDERSTAND THIS AGREEMENT, AND I ACCEPT AND AGREE TO ALL OF ITS TERMS AND CONDITIONS. I ENTER INTO THIS AGREEMENT VOLUNTARILY, WITH FULL KNOWLEDGE OF ITS EFFECT.

Client Signature

Date