Permanent Makeup Intake form

Restrictions - 

• Retinol/Retin-a must be discontinued 7 days prior to the procedure. (This will cause excessive bleeding)
• Injections (Botox, Radieese, JuvaDerm, Voluma, etc.) must be done 2 weeks before or after the procedure.
• Chemical Peel or Laser treatment may not be done within 60 days before or after procedure
• Use of Latisse must be discontinued at least 3 months prior to your eyeliner procedure
• Sunburn or Suntanned skin is dramaging to the skin and, will cause excessive bleeding. We cannot work on sunburnt or suntanned skin. 
• You cannot expose the are to the sun for 30 days before and after the procedure
• Do NOT schedule this procedure within one week of a water vacation.
• Stay out of stream rooms, saunas, hot yoga, swimming pools, lakes, oceans, etc. for a minimum of 1 week following procedure.
• Avoid working out or sweating for 1-week post-procedure. Sweat will prevent pigment from healing into the skin.
• Avoid alcohol and caffeine 1 days before the prcoedure.
• Do not take asprin, ibuprofen, niacin, fish oils or vitamin E 3 days prior to the procedure unless medicially necessary. 

Please inital the following after you clearly understand each statement.

I have read and understand the contents of each statement above. I acknowledge that this is a contract and that I have received no warranties or guarantees with respect to the benefits to be realized from, or consequences of, the aforementioned procedure(s). I further acknowledge that at the time of signing this consent I am of sound mind and capable of making independent decisions for myself. I hereby release and forever discharge and hold harmless Legacy Skin + Beauty and its owners, managers, employees and affiliates from any and all claims, damages or legal actions arising from or connected in any way with my micropigmentation, or the procedure and conduct used in my performing my tattoo, to the fullest extent allowed by the law.

By signing below, I acknowledge, understand and agree that:

the staff at Legacy Skin + Beauty does not practice medicine, does not accept health insurance, and have made no representation to the contrary;

the information provided on this form is accurate and complete to the best of my knowledge, and that Legacy Skin + Beauty is not responsible for complications or problems arising from any incorrect or omitted information;

some individuals will have complications related to semi-permanent makeup application. These complications are usually mild and last only a few days. However, extreme complications are always a possibility. I accept these risks and agree to hold Legacy Skin + Beauty and its employees and contractors harmless for same;
the staff at Legacy Skin + Beauty will use the information provided above to assess my suitability for the proposed micropigmentation services.

Cancellation – If you have an appointment, this time is reserved exclusively for you. If you must cancel your appointment, we require a minimum of 12-hour notice in advance for services. You are required to pay an additional $50 fee upon canceling your appointment before rescheduling. 

No Call/No Show - if you miss your appointment without prior notification, you will be charged the total amount of the missed procedure before booking any further appointments. I’m very considerate of your time; please do the same for me. 

Late Arrival – Arriving late will deprive you of valuable service time. It will be up to the practitioner's discretion to allow the services to continue or reschedule you for a future appointment. Upon rescheduling, you will be charged the rescheduling fee of $50.

Permanent Makeup Done by Another Technician – Recoloring permanent makeup done previously by anyone else is not “just a touch-up” since it is not the original work of our Provider. Therefore, fees start at the new permanent makeup prices. Two or more appointments may be necessary to achieve and complete most permanent makeup correction procedures. Note: Permanent Makeup Maintenance / TOUCH-UP – Touch-up’s are not included in the original procedure fee. Pricing – All prices quoted are subject to change without notice. 

Children Under 18 – Due to liability reasons, no children under 18 are allowed in the treatment area. We want to provide the best relaxing atmosphere for our clients. Thank you for your understanding. 

Cell Phones –Cell phone use is not permitted while permanent makeup services are rendered. 

All purchases and services are final, and there are NO refunds. 

Additional Treatment Policy - 

1. We reserve the right to refuse services to anyone. 
A. Undisclosed skin conditions (including sunburn/suntan)
B. Under the influence of drugs or alcohol
C. Any behavior, which is the practitioner's opinion, might compromise the artist’s or D, Studio’s ability to work safely and comfortably toward the desired results or disrupt other clients. 

2. Two or more appointments may be necessary to achieve and complete most permanent makeup procedures depending on each person’s skin. Touch-up fees will apply. 

3. Only clients receiving service will be allowed within the treatment room.

4. Your deposit of $100 upon scheduling is non-refundable. You can pay this below.