Ink'd Cosmetics Consent Form

I acknowledge by signing this release form that have been given the full opportunity to ask any and all questions I might have about obtaining a PMU tattoo from Ink'd Cosmetics. I acknowledge that all my questions have been answered to my full and total satisfaction. I specifically acknowledge that I have been advised of the facts and matters set forth below, and I agree as follows: Please read and initial.

I acknowledge that I have truthfully represented to Ink's Cosmetics that I am over eighteen (18) years of age.

I, hereby, give my permission to Ink'd Cosmetics to use, re-use, publish any photographic portraits or pictures of me.

I am not under the influence of alcohol or drugs.

I acknowledge that am not pregnant or breastfeeding.

I acknowledge that am free of any communicable disease(s).

I acknowledge that I could potentially have herpes infection breakouts in areas that I am susceptible to having these breakouts.

I acknowledge if I am diabetic, have any bleeding disorders or cardiac valve disease, I will list here:

List here:

I acknowledge that any acne, freckles, moles, or sunburn in the area to be tattooed might be agitated by the PMU tattoo process. (healing excluded)

I have NOT been on Accutane (Acne Medication) for at least 1 year.

I acknowledge that I would not have Botox injections 4 weeks before and to wait until at least 4 weeks after my PMU Eyebrow procedure.

I have not/will not have any chemical facials or have not/will not use any chemical facial creams 4 weeks before my PMU procedure.

I acknowledge it is not reasonably possible for an Artist of Ink'd Cosmetics to determine whether I might have an allergic reaction to the dyes, pigments, or processes used in my tattoo and I agree to accept that such risks are possible

I acknowledge and agreed to have the following PMU procedure(s) performed on me: Powder Brows (Ombre included), Satori brows, Correction, Lash enhancement, Eyeliner Top/Bottom, Decorative Eyeliner Top/Bottom, Lip Blush, Lip Neutralization, Camouflage, Inkless Stretch Mark Revision

Selected Procedures:

Total rates:

I acknowledge that variations in color and design may exist between any tattoos as selected by me and as ultimately applied to.

I acknowledge that tattooing is a permanent change to my appearance and that no representations have been made to me as to the ability to later change, alter or remove my tattoo.

I acknowledge that the obtaining of my PMU tattoo is my choice alone and I consent to the application of the tattoo and to any actions or conduct of Ink'd Cosmetics that are reasonable necessary to perform the PMU tattoo procedure.

I acknowledge that tattoo inks, dyes and pigments have not been approved by the Federal Food and Drug Administration and the health consequences of using these products are unknown.

I acknowledge that infection is always possible as a result of obtaining a PMU tattoo. I have been advised of the signs and symptoms of infection that indicate a need to seek medical care.

I agree to follow all instructions concerning the care of my PMU tattoo, and that any follow up appointments needed because of my own negligence will be done at my own expense.

I acknowledge receipt of written instructions advising me of proper care of my PMU tattoo and recognize the absolute necessity of following those written instructions. All questions about the body art procedure have been answered to my satisfaction.

Agreement of Follow Up on Brows: The rate of $150 is good within 6 months of initial session. *Follow up session within 6 months for Eyeliners & Lips are included with initial Full Rate.

I, have been fully informed of the risks of PMU tattooing but not limited to infections, scarring, hypo/hyperpigmentation of skin, any allergic reactions to tattoo pigments, numbing agents, latex gloves, & antibiotics. Having been informed of the potential risks associated with getting a tattoo, I still wish to proceed with the PMU tattoo application and I assume any and all risks that may arise from tattooing.

Please list history of long term medication usage(s) and current medication usage(s) This includes antibiotics prescribed prior to dental and surgical procedures:

Full Name

DOB

Address

Street Address Line 2

City/State

Phone/Text#

Email address

example@example.com

Client Signature

Date

Artist Name: Print/Signature

PERMANENT MAKE-UP/TATTOO CONSENT FORM

Client Information