Medical History Form and Informed Consent

Informed Consent
Date

MonthDayYear
Date
I, , as the client am voluntarily obtaining services from Julie Green at my own free will and have had the details of the procedure described fully to me as well was given the opportunity to ask any questions so that I may make an informed decision on whether I want to undergo this procedure.
I have been informed of the nature, risks, and possible complications and consequences of permanent skin pigmentation. 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, allergic reaction, 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 process and therefore not an exact science, but an art. I request the permanent skin pigmentation procedure(s) and accept the permanence of the procedure as well as the possible complications and consequences of the said procedure(s). *
I understand that if I have any skin treatments, laser hair removal, plastic surgery, or other skin altering procedures, it may result in adverse changes to my permanent cosmetics. I acknowledge some of these potential adverse changes may not be correctable.*
I have been told there is a chance of pigment migration.*
I understand the taking of before and after photographs of the said procedure(s) are a condition of such procedure(s).*
I give my permission to use my photos for the purpose of marketing. My pictures may appear in print or online.*
I certify I have read the above paragraphs and have had explained to my understanding this consent and procedure permit. I accept full responsibility for the decision to have this cosmetic tattoo work done. *
I have read and understand all the verbal and written pre and post-care instructions.*
Signature*

Powered by Jotform SignClear
PMU Artist Signature*

Powered by Jotform SignClear
Should be Empty: