Ombré Powder Brows Consent Form

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

I am over the age of 18 and will not be under the influence of drugs or alcohol at the time requested for the semi-permanent tattoo procedure.

I understand that permanent skin pigmentation procedure carries with it known and unknown complications / consequences associated with this type of cosmetic procedure, including but not limited to: infection, allergic reaction, scarring, inconsistent color and spreading, fanning or fading of pigments. I am aware that reaction to anesthetics can occur and accept all responsibility if reaction occurs.

I fully understand and accept that non-toxic pigments are used during the procedure and that the cosmetic enhancement achieved may fade over the course of 1-3 years. Even though color has faded, the pigment will stay in the skin indefinitely and may leave a light residue of color.

I understand the actual color of the pigment may be modified slightly, due to the tone and color of my skin. I fully understand that this is a tattoo process and therefore not an exact science, but an art. I request the procedure and accept the permanence of the procedure.

I understand that if I have any skin treatments, laser hair removals, plastic surgery or other skin altering procedures, it may result in adverse changes to my permanent cosmetics. I acknowledge some of these potential adverse changes may not be correctable.

I will receive, review and understand pre and post care instructions and will strictly adhere to such instructions. I understand that my failure to do so may jeopardize my chances for a successful procedure.

If I am on any medication for depression or any other mood altering prescription, I will advise my technician.

I understand that immediately after the procedure, the enhancement can be 20-50% darker than the desired result and can take 7-14 days to light. I understand that the true color will be visible 1 month after each application, and that the color may vary according to skin tones, type, age and skin conditions.

I understand that tattoo inks, dyes and pigments have not been approved by the Federal Food and Drug Administration (FDA) and that the health consequences of using these products are unknown.

I understand that taking before and after photographs of the said procedure are a condition of such procedure. I understand that KY Esthetics may use my images for marketing purposes.

I understand that my $50 deposit is NON-REFUNDABLE and is used to secure my appointment.

I certify that I have read and agreed to the above paragraphs and accept full responsibility for the decision to have this cosmetic tattoo performed.

This agreement will remain in effect for this procedure and all future procedures conducted by the licensed beauty professional. I can read English and understand that this consent agreement is legally binding. I certify that I completely understand and comply with the above as stated.

Client Name (Print)

Client Name (Signature)

Date

KY ESTHETICS