I hereby authorize to perform upon myself permanent cosmetic enhancement. If any unforeseen vcondition arises in the course of the procedure(s) I further request and authorize her to use her full judgement and do whatever he/ she deems advisable and necessary in the circumstances.
I understand that permanent cosmetic enhancement is an advanced form of tattooing. I accept responsibility for determining the color, shape and position of the enhancement as agreed during the course of my consultation.
I understand that permanent cosmetics are permanent and that if I choose to have them removed, it may be expensive and leave scars.
I understand that a sensitivity test for pigment does not guarantee that I will not have an allergic response. I am aware of that allergic response to pigment is rare and accept all responsibility if allergic response occurs. I am aware that a sensitivity reaction to anesthetics can occur and accept all responsibility if allergic response occurs. I fully understand and accept that non-toxic
pigments are used during the procedure and that the cosmetic enhancement achieved may fade over the course of 1-3 years. Even though the color has faded, the pigment will stay in the skin indefinitely and may leave a light residue of color. I understand that dyes, inks and pigments are not approved by the Food and Drug Administration (FDA) and the health effects are not known. I
accept that the highest standards of hygiene are met, and that sterile disposable needles are used for each individual client, procedure and visit.
I understand and accept that each procedure is a process requiring multiple applications of pigment to achieve desirable results, and that 100% success cannot be guaranteed. I understand that this is why I need to return for a control procedure that is not included in the initial price. I understand that the pigment may migrate under the skin, however this is a rare occurrence.
I understand that permanent cosmetic enhancement is an invasive procedure and the infusion process can be uncomfortable.
I understand that the control procedure, if required, will be performed 1-3 months after the initial procedure and that after a 3-month period I will be charged an additional fee for any procedures.
I understand that a control procedure takes place 3- 4 weeks after the initial application to allow the procedure site to fully heal. I will book the appointment when it is convenient for both parties.
I understand that loss of any eyelashes during the healing of permanent cosmetic eye enhancements will result in new eyelash growth over a 4 month period and that eyelash loss is rare and minimal. I understand that in rare cases that corneal abrasion can occur during eyeliner procedures.
I have been informed that combination/oily skin can/will cause the pigments to : fade prematurely, look more blurred or powdered under the skin, change in color or not retain at all. This has been explained to me and I wish to proceed and accept these risks and will hold Jazz Yee or AESTHX.co and/or her staff harmless if above said risks occur.
I take full responsibility and accept that this will or could happen. Appointments will not be made any sooner if the above mentioned issues occur. I do understand that all services performed will be non - refundable and final.
I am aware that the result of the procedure is determined by the following: Medication, Skin Characteristics - i.e. dry/oily/sun-damaged, Natural skin undertones, Alcohol intake and smoking, General stress, A compromised immune system, Poor diet, Post procedure care treatment I have been advised that upon completion of the procedure there may be swelling and redness of
the skin, which will subside within 1-4 days’ dependent on lifestyle. In some cases, bruising can occur.
I understand that immediately after the procedure the enhancement can be 30 to 50% darker than the desired result. I understand that the true color will be visible 1 month after each application, and that the color may vary according to skin tones, skin type, age and skin conditions. I appreciate that some skins accept color more readily than others and no guarantee of an exact effect or color can be given.
I am aware that that if I have had a previous eye disorder or eye infection and receive an eyelash enhancement, the disorder may recur again. I agree to use the correct medication to prevent
such a disorder recurring.
I am aware that even though my vision is not affected by permanent cosmetic eye enhancements.
I may wish to have someone drive me home.
I understand that scar camouflage procedures require skin color-matching tests before the procedure commences and will not give the result of an undetectable scar. I understand that there are few effective methods for pigment removal. Laser removal has proven successful,however is a process.
I confirm that potential complications for the procedure undertaken, and aftercare instructions have been explained to me. A written aftercare advice sheet containing more detailed information has been given to me and I agree that it is my responsibility to read this and follow the instructions on it, until the site has healed.
I agree to follow all pre-procedure and post-procedure instructions as provided and explained to me by the practitioner. I understand that infection and possible scarring can occur if I do not adhere to the said instructions. To my knowledge I do not have any physical, mental, or medical impairment or disability that might affect my well-being as a direct or indirect result of my decision to have the procedure done at this time. I am at least 18 years old. I am not under the influence of drugs or alcohol. I also consent to the taking of “before” and “after” photographs of said procedure(s).
I CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE CONSENT FORM AND THAT I HAVE REQUESTED TO HAVE PERMANENT COSMETIC ENHANCEMENT OF MY OWN FREE WILL.