Full Name*

I,   First Name*   Last Name*   acknowledge that I have been given the full opportunity to ask any questions which I may have. I also acknowledge that all my questions have been answered to my full satisfaction. I specifically acknowledge that I have been advised of the fact of the matters below, and agree as follows:

I acknowledge that it is not reasonably possible to determine whether I may or may not have a reaction to any of the inks, topical preparations, or processes in the procedure. I agree to accept the risk that such reaction is possible. I have informed the artist of any existing allergies, medical conditions, and prescribed medications.
First Name*   Last Name*   

I,   First Name*   Last Name*   acknowledge that complications are always possible as a result of the permanent makeup procedure, particularly in the event where pre & post-procedural instructions are not followed. I realize my body is unique and the artist cannot predict how my skin may react as a result of the procedure. I acknowledge that the procedure will result in a permanent change to my appearance and that no representations have been made to me as the ability to later change or remove the results. I understand that future laser treatments or other skin altering services or products may alter or degrade by permanent makeup. I understand that such changes are not the fault of the practitioner. I further understand that such changes may not be correctable through future permanent makeup or removal. I acknowledge that obtaining permanent makeup services is by my choice alone, and I consent to the application of the procedure and its risks, and to any conduct or actions of the practitioner reasonably necessary to preform the procedure. Tattoos should be considered permanent; that it can only be removed with a surgical or invasive procedure; and that any effective removal may leave permanent scarring.

I,   First Name*   Last Name*   understand that tattoo inks, dyes and pigments have not been approved by the federal Food and Drug Administration and that the health consequences of using these products are unknown. I further understand that the cosmetic tattooing service is permanent, and no promises have been made in the ability to remove or alter the results.

I,   First Name*   Last Name*   understand I must consult a physician prior to my lip tattooing appointment if I've ever had one or more cold sore outbreaks to seek anti-viral medication to prevent a breakout due to the lip tattooing. further, I   First Name*   Last Name*   understand that if I have a cold sore/HSV-1 breakout after the service, Mackenzie Rodriguez and Honey Skin & Lash Bar are not liable for any medial bills, scarring or pigmentation irregularities.