• Permanent Makeup Consent Form | Jennifer Nguyen Beauty Salon

Your privacy is very important.  The following information is only uses to assess your skin care goals, determine what treatments are appropriate for your skin condition and to avoid any possible reactions.

PHOTOGRAPHY CONSENT

POSSIBLE RISKS, HAZARDS, OR COMPLICATIONS

• Pain: There can be pain even after the topical anesthetic has been used. Anesthetics work better on some people than on others.
• Infection: Infection is very unusual. The areas treated must be kept clean, and only freshly cleaned hands should touch the areas. See “After Care” sheet for instructionon care.• Uneven Pigmentation: This can result from poor healing, infection, bleeding, or many other causes. Your follow-up appointment will likely correct any unevenappearance.
• Asymmetry: Every effort will be made to avoid asymmetry, but out faces our no tsymmetrical so adjustments may be needed during the follow-up session to correct any unevenness.
• Excessive Swelling or Bruising: Some people bruise or swell more than others. Ice packs may help reduce the swelling. The swelling or bruising typically disappears in1-5 days. Some people don’t bruise or swell at all.
• Anesthetics: Topical anesthetics are used to numb the area to be tattooed. Lidocaine, Prilocaine, Benzocaine, Tetracaine, and/or Epinephrine cream and/or liquidare used. If you are allergic to any of these, please inform me now.
• 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 MRImachine. You must inform your MRI Technician of any tattoos or permanent cosmetics.
• The alternative to these possibilities is to use traditional cosmetic and NOT undergo the Permanent Cosmetic procedure.

PERMANENT MAKEUP CONSENT

This form is designed to give information needed to make an informed choice of whetheror not to undergo a Microblading, and/or permanent makeup application. If you have any questions, please don’t hesitate to ask.Although Permanent Makeup Application is effective in most cases, no guarantee can bemade that a specific client will benefit from the procedure.  This is the process of inserting pigment into the basal layer of the epidermis. It is a form of tattooing.  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. The pigment is permanent but will fade over time. Additional Touch-Ups are likely needed within 12 months to 2 years.

Touch ups under 6 months are $250.00 per session deposit required upon booking.

Touch ups within 4 weeks are $150..00 To ensure the best results and retention of the brows color, a follow-up touch up should be scheduled.  

• Aftercare instructions have been explained to me and a written copy has been given to me to retain in my possession, which I will follow to the best of my ability. If I have questions, I will call or email.
• I understand that a certain amount of discomfort is associated with this procedure, and that swelling, redness and bruising may occur.
• I understand that Retin A, Renova, Alpha Hydroxy and Glycolic Acids must not be used on treated areas. They will alter the color and cause premature exfoliation of the pigment.
• I understand that tanning beds, pools, some skin care products and medications can affect my permanent makeup.
• I understand that successful color saturation can NOT be guaranteed due to hidden scar tissue.
• I will tell all skin care professionals or medical personnel about my permanent makeup procedures, especially if I am scheduled for an MRI.
• I accept the responsibility to explain to you my desire for specific colors, shape, and position for any procedure done today.
• I understand that implanted pigment color can slightly change or fade over time due to circumstances beyond your control, and I will need to maintain the color with future applications and a touch-up session within 4 weeks.
• I acknowledge that the proposed procedures(s)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.
• I have been advised that a touch-up session is highly recommended to make any adjustments to shape, color, and to fill any pigment thatmay have had poor retention. Touch-ups must be completed within 4 weeks of initial procedure.  The cost 💲 will be $150.00. 
• I have been quoted the cost of today’s appointment, and the cost of the touch-up. Touch-ups must be completed within 60 days of initial procedure to be considered a touch-up price.
• Due to the tedious and extensive nature of permanent makeup services, I understand that a refund will not be provided upon completion of the initial procedure or upon completion of the touch up procedure, for any reason.
• I certify that I have read or have had read to me the consents of this form. I understand the risks and alternatives involved in this procedure(s). I have had the opportunity to ask questions, and all of my questions have been answered. I acknowledge that I have reviewed and approved the material given to me, and I authorize Jennifer Nguyen to perform this service.
• I hereby release Jennifer Nguyen and affiliates from any liability arising from risks that are known and/or unknown during the microblading/PMU procedure and hold harmless to Jennifer Nguyen against any claims, expenses, damages, and liabilities.