Permanent Makeup Tattooing Consent Form

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Gender (optional)

Date of Birth

Date

Age

Referred By:

2. What area(s) are you having Tattooed today?

3. Who will be performing your tattoo procedure today?

The State of Florida prohibits tattooing anyone under the age of 18 without a form from the Health Department notarized and signed by BOTH parents or legal guardians. Anyone who appears under the age of 18 must supply a license or student ID with birth date to be copied for the file.

I understand that this is a cosmetic procedure completed by a tattooing process, and that this is a semi-permanent/permanent placement of pigment or ink and cannot be removed or easily changed like makeup that washes off and agree to release Beauty By Kitten from all manner of liabilities, claims, actions, and demands in law, or in equity, which I or my heirs might now or hereafter consider by reason of complying with my request of a tattoo procedure.

4. Please initial to acknowledge your understanding of our consent form:

I absolutely understand and accept that such procedure is a process, often requiring multiple applications of color to achieve desirable results and the 100% success cannot be guaranteed.

5. Please initial to acknowledge your understanding of our consent form:

I have been informed that the following possibilities may occur: Minor and temporary bleeding, bruising, redness or other discoloration; swelling; fever blisters on the lip area following lip procedures and/or fade or loss of pigment.

6. Please initial to acknowledge your understanding of our consent form:

I understand that many lasers & IPL’s (IntensePulseLights) including those used for hair removal, anti-aging, Photo Facials, removal of lines may or will turn permanent makeup dark or even black, or cause premature color loss. I agree to inform my esthetician or anyone operating such that I have permanent makeup.

7. Please initial to acknowledge your understanding of our consent form:

I fully understand that any service provider of Beauty By Kitten, when performing a permanent make-up procedure, does not act in the capacity as a medical professional. The suggestions made by any employee, contractor, or service provider are just suggestions based on their own professional knowledge or experience. They are not to be construed as, or substituted for advice from a medical professional.

8. Please initial to acknowledge your understanding of our consent form:

I understand that the permanent makeup procedure will be performed using appropriate techniques, instruments, and pigments or ink suitable to the technique I am choosing.

9. Please initial to acknowledge your understanding of our consent form:

I understand that the color selection and color results in all procedures are not an exact science.

10. Please initial to acknowledge your understanding of our consent form:

Depending on the procedure(s), which I select, I accept responsibility for determining the shape and position of eyebrows ,eyeliners ,lip liner and/or lip color. I understand the positioning of my procedures can be affected if I have elected or wish to select cosmetic surgery, Botox, Restylane, or any other procedures or injectables that tighten, lift, plump, or freeze the skin, and I assume this responsibility.

11. Please initial to acknowledge your understanding of our consent form:

I understand that this procedure will fade and this fading can alter the original pigment color and that this determines that it is a time for a touch-up visit.

12. Please initial to acknowledge your understanding of our consent form:

I understand that infections can occur due to lack of proper hygiene and/or pigment sensitivities. I fully understand that improper skin care and/or aftercare may lead to an infection of the treated area. I acknowledge that should my skin become infected due to improper care, I will hold my service provider & Beauty By Kitten, LLC harmless. I understand that proper care instructions have been made available to me online, and will be provided in paper after the completion of the procedure.

13. Please initial to acknowledge your understanding of our consent form:

I understand that proper aftercare is VITAL during the healing process. I understand that aftercare instructions will be given from Beauty By Kitten, LLC and I agree to follow those instructions, and ONLY those given. I will not follow instructions given by anyone outside of Beauty By Kitten, LLC or found elsewhere online. I also understand that if I do not correctly follow my aftercare instructions, a healed, lesser quality result is not the fault of any technician/operator of Beauty By Kitten. Any extra sessions, touch ups, or longer procedure time required to fix damaged brows due to non-compliance of aftercare WILL result in additional fees.

14. Please initial to acknowledge your understanding of our consent form:

I understand that if I do not abide by my aftercare instructions and compromise the integrity of the work and color, I may be dismissed as a client from Beauty By Kitten, LLC with no advance notice.

15. Please initial to acknowledge your understanding of our consent form:

I understand that the treated area may take up to two weeks to heal properly and aftercare instructions must be followed until the complete healing cycle is finished to ensure the highest quality results my body is capable of achieving.

16. Please initial to acknowledge your understanding of our consent form:

The permanent makeup which I have selected is a lasting impression that will gradually fade with age, exposure, and with skin care between 1 & 10+ years. I am, however, fully informed and aware that the work may fade sooner as a result of (but not limited to) AGE, LIFESTYLE, DEHYDRATION, MEDICATION, SUN EXPOSURE, SALT WATER, CHOLRINE, SKIN CARE PRODUCTS, MEDICATIONS, OILY SKIN AND OTHER SKIN CONDITIONS. I understand these factors are not able to be predicted. Should the work fade prematurely, I will not hold the service provider or Beauty By Kitten liable for such consequence. The skin is an organ with living, moving cells. There is no guarantee of tattoo lifespan.

17. Please initial to acknowledge your understanding of our consent form:

I certify that any medical information provided is accurate, true, and current to the best of my knowledge. I am informed and understand that not disclosing accurate and current pertinent medical information may directly affect the healing process and results of any permanent makeup and tattooing procedures. I also am informed and understand that not disclosing medical conditions can potentially place the service provider and associated staff at risk.

18. Please initial to acknowledge your understanding of our consent form:

I am informed and understand that if my skin is oily, that the work will fade sooner and heal with a lower final quality. I acknowledge that I will inform my service provider of my skin condition, and if my skin is excessively oily, and I still consent to this procedure, I will hold my service provider and Beauty By Kitten, LLC harmless in the event such occurs.

19. Please initial to acknowledge your understanding of our consent form:

I consent to the reproduction and use of my photo(s) and/or video(s) with the consent of the producing agent(s), Beauty By Kitten, LLC or any team member associated with Beauty By Kitten, LLC. Consent shall involve the use of my photos for any educational purposes, display to professional organizations, websites, social media and advertising thereof. This consent, as stated above, shall be a continuing consent for all procedures, past, present, and future. Written notice must be received from the client with 60 days notice to discontinue use.

20. Please initial to acknowledge your understanding of our consent form:

I have read this release form and confirm that all the information I have given on this document and the Customer Health History form is correct and to follow the General After Care Instructions. I understand that this is a release form and I agree to be legally bound by it.

Please upload a photo of your state ID. This is required by the Florida State Health Department

Client Signature

If client is under the age of 18, legal Parent/Guardian signature is required:

Artist Signature