PROCEDURE(S) DESIRED: Please write y or N to all of the following that apply. If you have any questions feel free to type them here. 

The following confidential medical information will be property of Jealousy Micro-pigmentation Studios (JMP Ventures LLC) This is required for the benefit and safety of the client in Obtaining any and all procedures performed by Jealousy Studios. Please read and fill out the information carefully. We hope your experience will be a pleasant and we are honored to serve you.

 ALLERGIES: Write Y or N to the following. Describe in the box below if you have ever had an allergic reaction to any of the following and described what happened below.

EYES/EYEBROWS: Answer yes or no to all of the following that apply. Please list any other issues below. 

LIPS: Write Y or N for all of the following that apply. Explain your answer if nessicary and feel free to ask questions here. 

SKIN: Write Y or N to all of the following that apply. Explain any further information that is needed. Feel free to ask questions here. 

GENERAL MEDICAL: Write Y or N to all of the following: If you have any of these conditions it does not nessicarily mean you cannot get this service, we just need to be aware prior to working with you.)

This history has been reviewed by the technician and my questions have been satisfactorily answered. I have also received and reviewed a copy of the Pre-Procedure Information Sheet and the After Care Sheet. I understand them and agree to follow them.

I am not Pregnant. 

I am over the age of 18 and in sound mind, body, and health. 

Informed Consent for Procedure

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY AND INDICATE THAT YOU UNDERSTAND WHAT THEY MEAN BY INITIALING NEXT TO EACH PARAGRAPH

To makeup practitioner and/or her associates

I have read and understand these risks listed above and they have been explained to me. I DID NOT JUST SIGN THIS DOCUMENT. I certify that the information in the above questionnaire is accurate and that is has been explained to me in detail and my questions have been answered. I accept full responsibility for any complications that may arise or result during or following the cosmetic procedure(s) to be performed at my request. I agree that I will give 24 hour notice if I need to cancel or I will forfeit my $50.00 deposit. I understand that my practitioner has a right to refuse service and that If I no show to my appointment there with be an additional deposit required to reschedule.

   No minors allowed in the treatment room and no more than one person May acompany you.

WE DO NOT TATTOO MINORS AT THIS ESTABLISHMENT!

If under the age of 18, Please wait in Waiting room accompanied by adult. We ask that you reschedule if you have a minor with you and there is not an adult to accompany them in the waiting area.

I personally reviewed the above information with my client, or client's representative.

We do have a large waiting area to accommodate. 

APPOINTMENT POLICY A consultation visit is free of charge.  A 24 hour notice is required to reschedule a consultation appointment. If you fail to cancel/reschedule this appointment within this time frame, a $50 prepaid deposit is required to schedule another consultation.  The $50 deposit will be applied toward any procedure of choice. Please do not bring children to appointment(s). After the consultation, a written price quote and a copy of these appointment policies are given.  Clients are never pressured to schedule a procedure.  In fact, all procedures should be carefully considered before scheduling them. To reserve an appointment for a procedure, a deposit of $50 is required.  The deposit will be applied toward the cost of the procedure. Pregnant or nursing women or anyone under the age of 18 will not be considered for tattooing. Please advise me now if any of these apply. If an appointment must be rescheduled, a 24 hour notice is required in order to fill the opening in the schedule. The deposit will be applied toward the rescheduled appointment. However, if you fail to reschedule and not come at your appointed time, the deposit will not be refunded or reapplied. The full price of the procedure will be due with another procedure at time of deposit. The first visit of the process is the initial Saturation visit.  The following visit is known as the Focus visit. As the names imply, the Saturation visit accomplishes the basic design and color saturation, and the Focus visit addresses perfection by focusing on balance, symmetry and detail of the healed result. There is no hourly charge for the Focus visits as long as they are completed within 30 days of the previous visit.  There are additional fees if not completed within this time period and we cannot guarantee our work if you do not attend your mandatory second visit. A cancellation/rescheduling of a Focus visit is required 24 hours in advance. If you fail to reschedule and not come at your appointed time, the complimentary pre-booked Focus visit is forfeited and an up Front Deposit of $150 ($50 additional hourly rates apply) per follow up procedure will be required. Please respect our time and our other clients time. Your Second Color Assessment appointment should be scheduled at the end of the first year and if a Touch-Up is needed, the charge is $275 per procedure. If, at the first year assessment, the touch-up is determined unnecessary, the charge for the second year touch-up is $300. The length of time one waits in between touch-up visits will determine all fees.All color fades and your cosmetic tattoo will require maintenance.  The amount of fading depends on several variables including medications and topical treatments, but is primarily due to sun (ultra-violet) exposure; therefore measures should be taken to protect your permanent cosmetics from the sun. I will not ask for a refund or hold accountable nor responsible any employee of JMP Ventures LLC if I decide to see a different artist outside of JMP Ventures LLC for my touchup service. I, the undersigned, received these appointment policies both verbally and in written form and I agree to comply with them. My signature is my consent to charge the aforementioned $50 non refundable deposit against my credit card should I decide to reserve an appointment.