Gleaux by Courtney LLC

acknowledge by signing below, that have been given the full opportunity to ask any and all questions which may have about the obtaining of any permanent cosmetic procedures from Gleaux by Courtney.

 I also acknowledge that all of my questions have been answered to my fill and total satisfaction specifically acknowledge that have been advised of the fact and matters set below, and agree as follows:

I acknowledge that it is not reasonably possible to determine whether might have an allergic reaction to any of the pigments, dyes, topical preparations, or processes used in the procedure; and l agree to accept the risk that such a reaction is possible. have informed the practitioner of any existing problems.

I acknowledge that complications are always possible as a result of the Permanent Makeup procedure, particularly in the event that postprocedural instructions are not followed. These risks include but are not limited to: infection, misplaced pigment, poor color retention and hyper-pigmentation.

I realize that my body is unique and the practitioner cannot predict how my skin may react as a result of the procedure. Color saturation can NOT be guaranteed

I acknowledge that the procedure will result in a permanent change to my appearance and that no representations have been made to me as to the ability to later change or remove the result. I understand that future laser treatments or other skin-altering procedures, such as plastic surgery, implants, and/or injections may alter and degrade my Permanent Makeup.

I further understand that such changes are not the fault of the practitioner. I further understand that such changes in my appearance my not be correctable through further Permanent Makeup procedures.

I acknowledge that the obtaining of Permanent Makeup procedure(s) is by my choice alone, and consent to the application of the procedure and to its attendant risks, and to any actions or conduct of the practitioner reasonably necessary to perform the procedure(s)

Aftercare instructions have been explained to me and a written copy has been given to me to retain in my possession, which I will follow to the best of my ability. If have any questions, will call or email you.

I understand that a certain amount of discomfort is associated with this procedure, and that swelling redness and bruising may occur.

I understand that Retin A Renova, Alpha Hydroxy and Glycolic Acids must not be used on treated areas. They will alter the  color and cause premature exfoliation of the pigment.

I understand that tanning beds, pools, some skin care products and medications can affect my permanent makeup. 

I will tell all skin care professionals or medical personnel about my permanent makeup procedures, especially if am scheduled for an MRI.

I accept the responsibility to explain to you my desire for specific colors, shape, and position for any procedure done today. 

I understand that implanted pigment color can slightly change or fade over time due to circumstances beyond your control, and will need to maintain the color with future applications and a touch-up procedure within sixty (60) Days. 

I have been advised that a touch-up procedure is highly recommended to make any adjustments to shape, color, and to fill any pigment that may have had poor retention. Touch-ups must be completed within sixty (60) days of initial procedure. 

I have been quoted the cost of today's appointment, and cost of the touch-up. Touch-ups must be completed within sixty (60) days of initial procedure to be considered a touch-up price.

I understand that some skin cells do not absorb pigments the same way as others cells of the same skin.

POSSIBLE RISKS, HAZARDS OR COMPLICATIONS

Pain: There can be pain even after the topical anesthetic has been used. Anesthetics work better on some people than others

Infection: Infection is very unusual. The areas treated mush be kept clean, and only freshly cleaned hands should touch the areas. See "After Care" sheet for instructions on care. 

Uneven Pigmentation: This can result from poor healing, infection, bleeding, or many other causes. your follow-up appointment will likely correct any uneven appearance.

Asymmetry: Every effort will be made to avoid asymmetry. but our faces are not symmetrical so adjustments may be needed during the follow-up session to correct any unevenness.

Excessive Swelling or Bruising: Some people bruise or swell more than others. Ice packs may help reduce the swelling. The swelling or bruising typically disappears in 1-5 days. Some people won't bruise or swell at all.

Anesthetics: Topical anesthetics are used to numb the area to be tatoced. Lidocaine, Prilocaine, Benzocaine, Tetracaine, and/or Epinephine cream and/or liquid are used. If you are allergic to any of these, please inform me now.

MRI: Because pigments used in Permanent Cosmetic procedures contain inert oxides, a low level magnet may be required if you need to be scanned by an MRI machine. You must inform your MRI Technician of any tattoos permanent cosmetics. 

There may be risks associated with the procedures of commercial body art, which includes permanent tattoos, body piercing and permanent cosmetic application, that may adversley affect the healing process if you have, or have had any of the following conditions:

. History of hemophelia (bleeding)

- History of skin diseases, skin lesions or skin sensitivities to soap, disinfectants, etc.

- History of allergies or adverse reactions to pigments, dyes or other skin sensitivites - History of epilepsy, seizures, fainting or narcolepsy Pregnancy or breast feeding/nursing

- hereby request and consent to the application of permanent color and consent to have the following procedures performed by Gleaux by Courtney LLC.

Please check any of the following which pertain to you:

We ask your permission to use before/after photos for the Gleaux by Courtney LLC website and portfolio for the customers who seek the same services. We would greatly appreciate it for these photos helped you to choose Gleaux by Courtney LLC.

I have read and understand the contents of each paragraph above. I acknowledge this is a contract and that have received no warranties or guarantees with respect to the benefits to be realized from, or consequences of, the aformentioned procedure(s) I further acknowledge that at the time of signing this consent to this procedure(s), was of sound mind and capable of making independent decisions for myself.

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