PREVIOUS PERMANENT MAKEUP RELEASE FORM for correction/removal
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Date of birth: *
Describe the tattoo to be lightened or corrected, what area, when was it done, etc.
Are you taking any medications or have any medical conditions your technician should know about?
YES
NO
If yes, please explain
Do you have any particular allergies? Removal ingredients include saline, citrus, fruit extract. If yes, please explain.
I understand that healed results when covering my previous permanent makeup cannot be guaranteed and oftentimes do not hold or heal as well as untouched virgin skin, and may require additional touch-up sessions, 6-8 weeks apart, at $150 each. Please sign or initial below. *
I understand that if there is any scarring in my skin from previous permanent makeup, the pigment may not hold or heal as well in these areas, and may require additional touch-up sessions, 6-8 weeks apart, at $150 each. Please sign or initial below. *
I understand that the artist may choose to turn away working on my previous permanent makeup for any reason. Please sign or initial below. *
I understand that microblading strokes may not hold or heal well over some previous permanent makeup, and that a natural powder ombre method is usually recommended. Powder ombre is a soft shading that is highly recommended for covering previous pigment, and even scarring. Please sign or initial below. *
I understand that as my results fade from this new permanent makeup treatment, over time they will fade and will still reveal the old pigment from my previous permanent makeup. Covering my previous permanent makeup does not make the old pigment disappear, as it will still remain in my skin unless I undergo removal first. Please sign or initial below. *
I understand that when an artist is working with my current shape from previous permanent makeup, sometimes the shape cannot be fixed, made even, or corrected perfectly without first undergoing removal. My technician can choose to turn away working with my previous shape for any reason. Please sign or initial below.
*
I understand that color correction and covering previous permanent makeup work requires a more advanced technician, and is not considered a touch-up from previous work. Color correction and new pigment requires more undertaking, and sometimes more paid sessions, when compared to virgin skin. Please sign or initial below.
*
The nature and method of proposed pigment (tattoo) lightening procedure has been explained to me including risks or possibility of complications during or following its performance. I understand there may be a certain amount of discomfort or pain associated with the procedure and that other adverse side effects may include minor and temporary bleeding, bruising, redness or other discoloration and swelling. Fevers blisters may occur on the lips following lip procedures in individuals prone to this problem. Secondary infection in the area of the procedure may occur, however if properly cared for, this is rare. Sign or initial below
I understand that several treatments may be needed in order to attempt to achieve my desired results, however I have not received any guarantees to the quality of the outcome of the process. Sign or initial below
I understand there are medical options available for pigment removal. I have decided to decline those methods. Sign or initial below
I understand that the unwanted pigment may not be successfully lightened to the point that it can no longer be seen, and that scarring as hyper-pigmentation or hypo-pigmentation, or other damages to the skin, which may be permanent, may occur during the process. I will not hold my technician and/or the distributor of tattoo removal products used in this attempted tattoo lightening or removal, liable for any damages that may occur to my person. Sign or initial below
Which of the following best describes your skin type?
I. Always burns, never tans
II. Always burns, sometimes tans
III. Sometimes burns, always tans
IV. Rarely burns, always tans
V. Brown, moderately pigmented skin
VI. Black skin
For skin types III to VI depending on skin health only saline removal is recommended. For skin types I to II and depending on skin health and pigment color Soft Beauty Angels removal is recommended. For skin types V and VI I understand that I am at higher risk for hyper-pigmentation and/or hypo-pigmentation than other skin types. I agree to risk involved. Sign or initial below
I understand that lightening tattoo pigment is difficult, if even possible in some cases. As a result I will not hold my technician or this establishment responsible for any resultant failure to lighten the unwanted pigment. Sign or initial below
I agree to submit to before and after photographs, and give permission to use such photographs for publication and/or for teaching purposes. Sign or initial below
I agree to follow all aftercare instructions. Sign or initial
I have been duly informed of the nature, risks, possible complications and consequences as listed above. I further understand that my technician is not a medical doctor. Sign or initial below
I understand all information listed above, have had my questions answered, and agree to all conditions and provisions of this document as evidenced by my signature below. I accept the risks for having this procedure done. Sign or initial below
I agree to and accept the fee for this session and any other fees for additional sessions. I understand there is no warranty or guarantee made to me as the result of this procedure and the final results can not be guaranteed. There are no refunds for this procedure, as results will vary and individual results are not guaranteed.
*
I understand/consent
Signature for consent:
*
Date
*
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Month
-
Day
Year
Date
Submit
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