LIP BLUSH

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Name*

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Date of Birth (mm/dd/yyyy)*

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I hereby declare that I have been informed, in detail, about the PMU Lip Blush method and procedure which will be performed. I was informed that needles are used for the treatment to inject color pigments into the upper layers of the skin.

I am aware that it is not possible to predict how durable and intensive the lip color will be and that durability and color intensity depend on age, skin type, and environmental conditions of the treated person. I am aware that the treatment with the pigmenting needles can cause skin irritation and minor inflammation of the skin which usually disappears within 24-36 hours. If predisposed to cold sores, start taking medication immediately, as trauma to the lip can cause an outbreak and may affect pigment retention.

I have been informed that the pigments will appear darker within the first few days immediately following the procedure than the final result. It will be necessary to undergo a follow up treatment. I have been informed of the section of skin to be pigmented may be anesthetized/numbed with a surface anesthetic.

I have been informed that medicines affect different individuals in different ways. Just because side effects have occurred in some cases, it does not mean they will occur to me. Some common side effects anesthetics may include: Allergic reaction, light headedness, drowsiness/dizziness, vomiting, numbness of the tongue, unusually slow heartbeat.

I authorize the use of my photographs taken by the technician to be used on social media and shown to potential clients.

The result of drawing and color chosen has been presented to me before the pigmentation process has been started.

Furthermore, I state that:

I am not diabetic I am not hemophiliac
I am not allergic to Red Lake #5
I do not test positive for the HIV or Hepatitis Viruses
I am not pregnant

List any allergies, if you have none then put N/A*

I have informed the Technician of any medication I am currently taking, which may affect blood coagulation during the Lip Blush procedure, these include:

Blood Thinners
Sleeping Pills
Blood Pressure Medications
Chemical Peels
Diuretics
Hormone Replacements
Painkillers
Antibiotics
Tranquilizers
Immunosuppressants
Dermatological Medications (Accutane)

I hereby declare that I am not intoxicated and that I am fully aware of the treatment procedure and that I understand the above statement to be true. I give my consent to have PMU: Lip Blush performed and assume full responsibility for the outcome. I do not and will not hold HAYLEY STPIERRE COSMETIC STUDIO responsible or liable should the result may not be as discussed or as I had imagined.

The color of your permanent makeup procedure will be 50% darker immediately after the treatment. Do not worry it will start to get lighter between 4-10 days this is perfectly normal and the true healed color will take about 4-6 weeks to come through. In some cases, it can look like the permanent makeup pigment color has disappeared which is due to the healing layers of the skin obscuring the color temporarily. At this point, you just have to let it develop and certainly do not have any further permanent cosmetics work carried out during the 4- 6 weeks period. Should an infection occur, seek medical attention. Clients who have been prescribed an antibiotic cream should follow the instructions of their medical practitioner.

Healing will take up to four weeks and it is perfectly normal for the treated area to scab. These scabs will fall off within a few days. It is normal for the color to fade during the two weeks following the treatment. Your skin will be temporarily sensitized after the treatment and you should adhere to the following instructions for the next seven (7) days. This will help avoid infection and will allow time for the skin to recover. If you apply makeup during the 7 days following the treatment, you do so at your own risk.

You can cleanse the treatment area two or three times a day if needed, using warm water, and a lint free wipe. Apply aquaphor with a cotton swab only (no fingers). Keep moist at all times with aquaphor during the healing process.

During the post treatment period, please try to avoid the following:

Spicy and salty food
Kissing
Using soaps, cleansers, creams or makeup on the treated area.
Facial treatments, waxing and using any form of bleach.
Any abrasive products, rough towels or similar.
DO NOT TOUCH or PICK the small scabs that may appear after the treatments.
Taking hot baths, saunas, steam, swimming pools, salt water, any direct shower spray, sunbathing, and tanning beds.

Aftercare procedures have been explained to me in detail and I have read the instructions given on this form. I read, understood and a copy of post procedure instructions were given to me for reference.

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CONSENT FORM