Cosmetic Tattoo Consent Form

Cosmetic Tattoo Consent Form

Malorie Harris LLC
-I accept the responsibility to explain to you my desire for specific colors, shape, and position for any procedure done.

-I understand that implanted pigment color can slightly change or fade over time due to circumstances beyond your control.

-I acknowledge that the proposed procedures involve risks inherent in the procedure, and have possibilities of complications during and/or following the procedures such as: infection, misplaced pigment, poor color retention and hyper-pigmentation.

-If I have previous permanent makeup from another studio, I understand that Malorie Harris LLC cannot remove any previous work but can only add pigment.
This form is designed to give information needed to make an informed choice of whether or not to undergo a permanent makeup application. If you have any questions, please don't hesitate to ask.

Although cosmetic tattoos are effective in most cases, no guarantee will be made that a specific client will benefit from the procedure.

This is the process of inserting pigment into the dermal layer of the skin.

All instruments that enter the skin or come in contact with body fluids are disposable, and disposed of after use. Cross contamination guidelines are strictly adhered to.

Generally, the results are excellent. However, a perfect result is not a realistic expectation. It is usual and advised to expect a Touch-up after healing is completed.

Initially the color will appear more vibrant or darker compared to the end result. Usually within 5-7 days the color will fade 40-50%, soften and look more natural.
Signature

Clear
Client Information
Full Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Phone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pre-Procedure Questionnaire
Acknowledgment and Waiver
I understand I cannot be under the influence of drugs or alcohol during the procedure.
I have read the following PDF regarding contraindications and agree to all terms.
I have read the following PDF regarding before care and will follow the instructions.
I agree that the studio does not have a way of identifying if I am allergic to the elements or ingredients or medications (Licocaine, Tetracaine, Epinepherine, Dermacaine, Benzyl Alcohol, Carbopol, Lecithin, Propylen Glycol, Vitamin E Acetate, etc) that will be used for my tattoo.
I have read the following PDF and understand that I need to take care of the tattoo by following the after care instructions and failure to do so could cause infection or premature pigment fading.
I understand if I use antiaging skin care with ingredients such as Retin-A, Glycolic Acid, or Alpha Hydoxyl, that these products will cause premature pigment loss and need to be discontinued 7 days pre procedure and 30 days post procedure..
I understand that my initial permanent makeup appointment will not yield final results and requires a 6-8 week perfecting touch up apt. Touch ups must be completed within this time frame to be considered a touch up price.
I understand that symmetry is the goal but faces are not perfectly symmetrical and the artist will do her best to create the best shape for my face.
I allow my tattoo to be photographed and be used for Malorie Harris LLC’s portfolio.
Signed Date

MonthDayYear
Date
Client Signature

Clear
Should be Empty:

Cosmetic Tattoo Consent Form

Client Information

Pre-Procedure Questionnaire

Acknowledgment and Waiver