PAIN: There could be pain even after the topical anesthetic has been used. Anesthetics work better on some people than others. Please communicate with me how you’re doing throughout procedure. INFECTIONS: Infection is very unusual. The areas treated must be kept clean and only touched with freshly cleaned hands. If you follow the specific after care instructions provided to you infection is highly unlikely UNEVEN PIGMENT: This can be a result of poor healing, infection, bleeding, or other causes. Your follow up appointment will likely help correct any uneven appearances. ASYMMETRY: Every effort will be made to avoid asymmetry but our faces are not symmetrical so adjustments may be needed during the follow up session to correct any unevenness. EXCESSIVE SWELLING/BRUISING: Some people bruise and swell more than others. Ice packs may help the bruising and swelling. It typically disappears within 1-5 days. Some people do not bruise or swell at all. ANESTHESIA: Typical anesthetics are used for numbing the area to be tattooed. Lidocaine, Tetracaine and Epinephrine in a cream and gel form are used. If you are allergic to any of these please inform your artist immediately. MRI: Because pigments used in permanent cosmetic procedures contain inert oxides, a low level magnet may be required if you need to be scanned by an MRI machine. You must inform your technician of any tattoos or permanent cosmetics. ALLERGIC REACTION: Less than a 0.25% of the population has an allergic reaction but there is a small possibility. Doing a spot test is recommended if you have had reactions in the past.

I will follow the pre-care instructions given to me to the best of my ability. I understand that if I don't follow these guidelines carefully the procedure may be compromised. The aftercare instructions will be explained to me and a copy will be given to me to keep, which I will follow to the best of my ability. I understand that all permanent cosmetic procedures have possible risks associated with them. Some of the possible risks of micropigmentation (while rare) include: Allergic reaction, infection, misplaced pigment, poor color retention, and hyper-pigmentation. I will tell all future skin-care professionals and/or medical personnel about my permanent makeup procedure where applicable, as it may have an effect on other procedures (especially if scheduled for an MRI) I understand that a certain amount of discomfort is associated with this procedure and that swelling, redness and bruising may occur. I accept responsibility to communicate desired position, shape and color during pre-draw process. I understand water, sweat, oils and other moisture on the treated area during the healing process will make pigment blur and/or affect color retention. I understand that products containing Retin-A, Renova, alpha hydroxy, salicylic acid, and glycolic acids must NOT be used on the treated area as they will alter the color. I understand that sun and tanning beds will make the treated area fade. Once healing process is complete I am to wear an SPF when outdoors. I understand that implanted pigment color may slightly change or fade over time due to circumstances beyond control and that I will need to maintain the color with future applications and a touch up session within 10 weeks. I give my artist permission to take photos and/or videos of her work. These images may be posted online in association with the procedure, but my name will not be depicted or connected to my image.

I authorize Tatyana Brown, permanent cosmetic tattoo artist, to perform my elective permanent make up procedure. The risks of the procedure have been disclosed to me. It has been represented to me that no guarantees, warranties, promises, commitments or other statements as to the results of this treatment have been made, and I acknowledge that I have received no particular representations or guarantees, and I am consenting to the procedure at my own risk. I have revealed or disclosed on the Medical Profile form all conditions and circumstances regarding my health history, medications being taken, and any past reactions to products used or medications taken. Additional conditions could occur or be discovered during or after the procedure, which could affect my ability to tolerate the procedure. I understand the success of my permanent cosmetics process requires my careful maintenance. I understand that I must strictly adhere to all aftercare instructions. I understand that failure to follow after-care instructions may result in infection, pigment loss, or discoloration. I agree to and understand all of the above information and consent that all of the information is correct to the best of my knowledge. I, as herein signed, release, give up, acquit and discharge my permanent cosmetics professional at Wink by Taty, LLC from any claims or damages of any nature. I agree to pay any costs of legal services necessary to further effect or confirm said release. I further agree that this release shall be in contemplation of any possible damages, either known or unknown at the signing of this waiver and release form, and said damages are specifically waived following the signing of this waiver and release form. I further agree to hold my permanent cosmetics professional nameless and harmless from any and all damages. I release my permanent cosmetics professional from any responsibility for pre-existing conditions I have not revealed, or any consequential change to those conditions that arises subsequent to the procedure. I understand that I am responsible for any medical treatment I may need as a result of getting this procedure. I accept full responsibility for these and any other complications, which may arise or result during or following the procedure, which is to be performed at my request.

Please read the following statement and sign and date on the line to indicate that you have read, understand and accept the following statement: I, the client herein signed, certify that I have read and fully understand the above waiver and release form. I certify that I have read all applicable literature given to me. I have completed the above forms to the best of my knowledge. I accept the explanation of potential complications and risks described herein. I certify I am of sound mind, and I am fully capable of executing this waiver and release form for myself. I, the undersigned client, acknowledge and fully understand that there might be other unknown risks not reasonably foreseeable at this time. I, the client herein signed, for the purposes of documentation, hereby consent to this procedure.