FancyFace Client Consent Agreement Logo
  • Client Consent Agreement

    Client Information
  •  - -
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • NO PERSON MAY BE TATTOOED WHO APPEARS TO BE UNDER THE INFLUENCE OF ALCOHOL OR DRUGS

  • Disclosure and consent for implantation of pigment

    You have to the right to be informed, so that you may make the decision to, or not to undergo a permanent makeup and/or microblading procedure, after knowing the risks and hazards involved. This disclosure is to inform you so you may give or withhold your consent. By signing & initialing this disclosure, I agree that I have read and understand the following statements completely:

  • POSSIBLE RISKS OR COMPLICATIONS: 

     Anesthetics: Topical anesthetics are used to numb the area. Lidocaine, Prilocaine, Benzocaine and Tetracaine are used. If you are allergic to any of these, please inform your Technician now.

     Pain: There can be pain even when an anesthetic has been used. Anesthetics work better on some people than on others. 

     Swelling/ Bruising: Mild to excessive bruising and/ or swelling may be experienced. Ice packs may help reduce this and typically disappears in 5 to 7 days.

     Infection: The risk of infection is possible. Although very unusual, the areas treated must be cared for according to the "After Care” instructions provided.

    Uneven Pigmentation: This can result from poor healing, infection, bleeding, or many other causes.The follow up appointment will likely correct this. 

     Asymmetry: Every effort will be made to avoid asymmetry. 100% of all faces are not symmetrical. The Technician will balance the design, giving as much symmetry as the skin, muscle and bone structure will allow. The follow up session can also correct unevenness.

     MRI: Some pigments contain inert oxides. You must inform your MRI Technician of any tattoos You must wait at least 15 days after the procedure to get an MRI.

    • These procedures attempt to improve, enhance, and accentuate but no guarantee is made to me as to the final result of this permanent makeup/microblading procedure. Understand that the procedure(s) may not reach expectations. 
    •  Many factors can affect the outcome of this service(s), which include, but are not limited to, issues such as stress, hormonal changes, poor after care, exposure to chemicals, heat, sun, and certain medications and illnesses.
    • People have different skin types and do not have 100% even facial/bone/muscle structure and features. This causes the reactions and outcome of these procedures to vary in each individual.
    • There is a possibility of discomfort or pain during the procedure and during the healing process. There is a possibility of bleeding, swelling, and allergic reactions to the pigment or other materials used.
    •  Permanent Makeup & Microblading is considered tattooing and is permenant; however, it may fade with time and can only be removed with any effective removal treatment that may leave permanent scarring or disfigurement.
    •  Misplacement of the pigment can occur, under rare circumstances, requiring excision of the misplaced pigment. In rare cases. there may be permanent loss of eyelashes.
    • Before and after photographs will be taken and used for any purposes.

     

  • Client Responsibilty to Inform the Technician

  • * I am at least 18 years or older
    * I am free from drug and alcohol use or any other substances
    * I understand that it is my responsibility to advise the technician of any concerns I may have before they begin the procedure, even though I may have written it on the form. 

  • Medical History

     

  • * I understand in rare instances, there may be a concern about an allergy or health condition that would prevent me from being a candidate for the requested procedure and that the authorized member of the FancyFace team may, upon review, deny permission for me to receive the procedure(s)

  • After Care Instructions 

    Each time tattooing is performed the client (and if applicable, the parent or guardian) shall receive oral and written instructions on the care of the area tattooed) 

     For beautiful lasting results, to prevent infection, pigment loss and/ or discoloration:

    • Do not touch, scrub or pick the procedure area. If needed, you may take an over the counter pain reliever.
    • Apply clean, cold pads for 15-20 minutes to reduce swelling. Only if instructed, use sterile bandage(s) or other sterile dressing(s) when necessary. 
    • Keep the procedure area clean- Properly cleanse the tattooed area morning and night with a mild antibacterial liquid soap, pat and air dry before applying ointment. 
    • Keep the procedure area dry- Avoid swimming pools, jacuzzis, saunas, etc and direct contact with water while bathing.  
    • Keep the procedure area protected- Sparingly apply ointment with a cotton swab over procedure area only and blot off excess with a clean tissue. 
    • For the first three days following procedure apply Bacitracin every one to two hours to avoid scabbing. On day four start applying Vitamin A & D ointment. 
    • Keep the procedure area away from heat and chemicals. Do not use facial cleansers, astringents, creams, makeup  on or near the procedure area for 15 days. 

    • For at least two weeks, minimize exposure to the sun. 

     

    What to expect post- procedure:

    • The procedure area will be will be swollen, itchy and possibly bruised for the following three days which is likely to make the design look uneven. Days two and three are the worst but by day four you should begin to see improvements.  
    • The color used for the procedure will appear brighter and more defined for the following seven days. As the procedure area flakes off, the color will soften by 40 to 60 percent and the area will gradually darken. True color and final results may not be seen until the healing process is complete, typically four weeks post procedure.
    • A touch up is necessary following the procedure, as the color will fade over time. Following first time procedures, a touch up is critical and must be done within six to eight weeks following. If a touch up is included, it must be done within 3 months from the date of the original procedure. It is the clients responsibility to set up the appointment.  
    • For eye procedures, the eyes may need to be flushed with eye drops and if you resume wearing mascara, purchase a new tube to avoid bacteria.
    • For lip procedures, drink fluids with a straw and cut food into small bites to eat following the procedure. Do not let food touch your lips to avoid infection and seal lips with ointment before brushing teeth. Do not use whitening toothpaste for 10 days. Do not stretch your lips.

     
    There are no refunds on procedures or touch ups.

     

    STATEMENT OF ACKNOWLEDGEMENT:


    Several days following the procedure, you may experience bruising and/or redness around the area. The area may be swollen, sore and/ or itchy. I understand there no refunds for procedures or touch ups.

    The client shall consult a health care practitioner at the first sign of infection or an allergic reaction, and report any diagnosed infection, allergic reaction, or adverse reaction resulting from the tattoo to the artist and to the Texas Department of State Heath Services, Drugs and Medical Devices Group, at 1-888-839-6676.


    By signing below, I agree that I fully understand the questions, terms, disclosures and conditions of this Consent Agreement. I was given an opportunity to ask questions and all have been explained to me to my full understanding. I have recieved a copy of applicable written care instructions and I have read and understand such written care instructions. I, further, release FancyFace Permanent Cosmetics, Alliance Tattoo LLC and it’s representatives and subsidiaries of all claims for injury or loss, seen or unseen that may occur as a result of the procedure(s). I certify that this Consent Agreement was completed by me and that all the entries and information on it are true and complete.

  • An artist may not tattoo a person younger than 18 years of age without meeting the requirements of 25 Texas Administrative Code, 229.406(d), whose parent or guardian determines it to be in the best interest of the minor child to cover an existing tattoo. 

  • Clear
  • Fees/ Follow Up/ Touch Ups

  • I understand that this procedure(s) may take more than one visit. Also, touch- ups, as time goes by will be needed. My technician has discussed the fees with me below. 

  • Total Fees $   *    
    Touch Up Fee (If Applicable) $     

      *   

  • prevnext( X )
      DepositA non refundable deposit of $100 is required to schedule any procedure.
      $100.00
        
      Total
      $0.00

      Credit Card

    • Photo Consent and Release

    • {input25:shorttext-4}{input25:shorttext-4}
      I {name}, do hereby agree to the following.

      I am allowing FancyFace Cosmetics or delegated photographer to take photos of my treatment/ procedure and or treated areas for the purpose of monitoring my progress

       

    • I give permission for my photos to be used for education

      I give permission for my photos to be used for education

      I give permission for my photos to be used on the FancyFace Cosmetics Social Media      

      At my request, my identity will remain anonymous      

      At my request, my photos will only be used for my chart      


      Print Name:      

      Signature:      

    • For Office Use Only:

    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof
    • Needle/ Blade Used
      Color(s)/ Manufacturer
      Catalogue Number      

    • Should be Empty: