PMU Consent Form

Permanent Makeup Consent Form

Form provided by Eyedentity Studio | 3243 NE 45th St, Seattle, WA 98105 | 206.567.7705
This agreement is entered into by and betweeen technician and .

In consideration of the conditions and covenants set forth
in this agreement, the technician and client agree as follows:
I, client as a client, have had the procedure described to me so I may make an informed decision whether or not to go through with this procedure.
I, client voluntarily request as my permanent cosmetic technician, technician technical assistance as they may deem necessary to perform on my body the following procedure(s):
Procedures

MicrobladingPowder BrowsHybrid BrowsMicro-needlingScalp Micropigmentation
Service Fee $
2. Representation/Risk (Please Check)

It has been explained to me that the procedure to be used is referred to as micro-pigmentation or intradermal implantation, the process of implanting micro- deposits of pigment into the epidermal layer of the skin. Micro-pigment implantation is a form of tattooing used for the purpose of permanent cosmetic makeup and skin imperfection camouflage.
It has been explained to me that the practice of this procedure is not an exact science. Color may not match perfectly or appear exactly as expected. Over the months and years following the procedure, softening, fading or change of color of the pigment may occur. I understand touch ups are available at additional costs.
I understand that there is a possibility of hyper-pigmentation resulting from the procedure, especially for individuals prone to hyper-pigmentation from a scar or other injury.I realize the procedure will probably result in permanent and irreversible color change in the skin area treated. However rare, some of the possible complications resulting from this procedure may include infection, scarring,swelling, bruising, numbness, and post procedure discomfort, allergic reaction to one of the pigments or anesthetic agents (topical and oral Should an allergic reaction to one of the pigments occur, it may be removed surgically or by laser.
3. Release of Liability

I hereby authorize my technician to take full face photographs of the work performed both before and after treatment, and I further authorize the use of said photographs to be used for marketing purposes.
I understand that no guarantee has been made to me and that this procedure may take more than one time to achieve wanted results.I have been told that there may be risks and hazards related to the procedure planned for me.
I have been told that this procedure will most likely involve some pain and discomfort.I have been told that the markings are permanent and there is a risk of infection following the procedure.
I have been told there is a chance I may experience a corneal abrasion from the eyeliner procedure.I have been told that there is a chance of allergic reaction to pigment and that my body may reject pigment.I have been given an opportunity to ask questions about the procedure and the risks and hazards involved; I believe that I have sufficient information to give this informed consent.
I certify this form has been fully explained to me and I have read over it, or it has been read to me. I understand the terms of this document.
By typing my name in the box below, I agree to the terms of receiving skin and facial services from Eyedentity Studio. *
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Permanent Makeup Consent Form