By signing below, I acknowledge that I specifically acknowledge that I have been advised of the facts and matters set below, and I agree as follows:
I am over the age of 18, am not under the influence of drugs or alcohol, am not pregnant or nursing and desire to receive the indicated permanent cosmetic procedure. The nature and method of the proposed procedure has been explained to me as having the usual risks inherent in the procedure and the possibility of complications during and following its performance. I understand that there may be a certain amount of discomfort or pain associated with the procedure and that other possible adverse side effects may include: minor and temporary bleeding, bruising, redness or other discoloration and/or swelling. Secondary infection in the area of the procedure is rare if properly cared for, but may occasionally occur. I understand the permanent skin pigmentation procedure carries with it known and unknown complications and consequences associated with this type of cosmetic procedure, including but not limited to: infection, scarring, inconsistent color, and spreading, fanning or fading of pigments. I understand the actual color of the pigment may be modified slightly, due to the tone and color of my skin. I fully understand this is a tattoo/pigment removal process and therefore not an exact science, but an art. I request the pigment removal procedure(s) and accept the permanence of the procedure as well as the possible complications and consequences of the said procedure(s).
I have informed the practitioner of any and all of my known allergies. I acknowledge that it is not always reasonably possible to determine in advance whether I might have an allergic reaction to any of the pigments, dyes, topical preparations, or processes used in the procedure; and I agree to accept the risk that such a reaction is possible. I acknowledge that complications as a result of semi-permanent makeup procedures may occur, particularly in the event that the post-procedural instructions are not followed, and accept full responsibility for such complications. I realize that my body is unique and neither Mojo Master, Inc. nor its employees or contractors can predict how my skin may react as a result of the procedure. I acknowledge that the procedure may result in a long-lasting (many years) change to my appearance and that no representations have been made to me as to the ability to later change or remove the results. I understand and accept that such changes are not the fault of Mojo Master, Inc. or its employees or contractors. I further understand that such changes or degradation in my appearance may not be correctable through further semi-permanent makeup procedures.
I acknowledge that obtaining pigment removal treatments is my choice alone, and I consent to the procedure and Its risks, and to any actions or conduct of Mojo Master, Inc. and its employees and contractors reasonably necessary to perform the procedure. I understand that I will have the opportunity to approve the design and color of the semi-permanent makeup to be applied, and I accept responsibility for the same.
IMPORTANT: HISTORY OF COLD SORES - LIPS: Fever blisters may occur on the lips following lip procedures in individuals prone to this problem. Pre-medicating with a prescription medication to prevent cold sores is mandatory for client's with a history of cold sores. NOTIFY YOUR TECHNICIAN PRIOR TO TREATMENT. You will need to consult with and strictly follow my doctor's instructions before contemplating any permanent cosmetic procedure around my lips.
I understand that several treatments WILL be needed in order to attempt to achieve my desired results. I have not been given any guarantees as to how much pigment will actually be removed from the skin.
I understand that the unwanted pigment may not be successfully removed, and (in a rare case) that permanent scarring can result in an attempt to remove the pigment, as well as possible hyperpigmentation, hypopigmentation, or other damage to the skin, which may be permanent.
I understand there are other options and methods available for pigment removal/lightning. I have decided to move forward with the Saline removal/lightning.
I will not hold Mojo Master, Inc. or its practitioners responsible for any resultant failure to remove, partially, totally or to lighten.
I will not hold Mojo Master, Inc. or its practitioners and/or the distributor of tattoo removal products used in this attempted tattoo removal, liable for any damages that may occur to my skin.
I agree to take “before” and “after” photographs and to conform to all rules and regulations established by Mojo Master, Inc. or its practitioners, to ensure a successful removal/lightening of the unwanted pigment/tattoo.
I agree to follow all aftercare instructions.
I have been informed of the nature, risks, possible complications and consequences as listed above. I further understand that Mojo Master, Inc. or its practitioners are not medical doctors and this procedure is an art and not an exact science and have neither asked for nor received any guarantees or promises as to the results obtained.
I acknowledge by signing this consent form, I have been given the full opportunity to ask any and all questions about saline removal/lightening procedure(s), its process, and the risk involved from Mojo Master, Inc. and its Practitioners. The decision to have saline removal/lightening procedure(s) performed is my own and I understand and accept all risks involved, therefore releasing Mojo Master, Inc. or its practitioners from any liability. Saline removal/lightening is not a medical procedure. NO REFUNDS……NO EXCEPTIONS.