PMU Crew Consent Form 2024

Client Name*

First NameLast Name

Date of birth*

Date

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Where did you hear about PMU Crew?*

Please take a moment to answer the following questions

Are you presently taking any medications?*

YesNo

Have you had a drink and something to eat within the last 2 hours prior to the permanent makeup procedure?*

YesNoN/A

Are you pregnant or breastfeeding?*

YesNo

Do you have any allergies to cosmetics, Iodine, or Latex?*

YesNo

Please specify

Service

Have you had any allergic reactions to any chemical or tinting services before? Please specify below.*

Do you have a wound, scar, pimple or mole in the area we are treating?*

YesNo

Are you taking any skin medications, ABA, BHA or Retinol?*

Have you had any Microblading or Semi Permanent brow procedures done in the last two months?*

YesNoN/A

Have you taken any blood thinning medication, ibuprofen, aspirin, or alcohol in the last 24 hours? Please specify below.*

YesNo

I agree with If I experience any pain or discomfort during the session, I will immediately inform the technician so that the products and/or technique may be adjusted to my level of comfort.

I further understand that the service should not be construed as a substitute for medical examination, diagnosis, or treatment. If I have any medical concerns I will consult a medical professional as soon as possible.

I understand that with these procedures the possibility of fainting, vomiting, and or infection including bacterial endocartitus for patrons with a heart condition is possible.

I hereby declare and acknowledge that I am 18 years of age or the responsible party and not under the influence of alcohol or drugs or anything that might impede my judgement while signing this waiver.

I also understand that there's a binding agreement that releases PMU Crew and therefore the artist from all liability. I understand that this agreement is binding and then I must read and fully understand all the information above.

I have read and fully understand the consent form and everything to my best ability. I am not miss representing myself nor have I withheld any medical information surgical state or condition.

I confirm and agree that I wish to engage in services and or beauty procedures on myself.

Time

Hour Minutes

AM/PM Option

I give permission for the use of photos and videos of before and after to Allyssa to use according to social media, advertising, and whatever she sees fit. *

Date*

Date

Signature

Do you have sensitive skin or any disease such as diabetes, lupus, or hemophilia that might affect the procedure?*

YesNoN/A

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