Informed Consent from Microblading and Permanent Makeup

Please read the following statements carefully. Microblading and/or cosmetic tattooing, intended to be semi - permanent lasting average 12 - 18 months. On rare occasions, the pigment may migrate under the skin. The procedure of eyebrow tattooing and/or microblading may be uncomfortable. Although extremely rare, there might be an immediate or delayed allergic reaction to pigment. A negative patch test result does not guarantee that you will not develop an allergic reaction after the full procedure. Allergic reactions to anesthetic can occur. Permanent cosmetics cannot be performed if you are pregnant or nursing, or anyone under the age of 18. Infections can occur if aftercare instructions are not followed correctly. There may be swelling and redness following the procedure. You may experience minor bleeding. If you have an MRI scan within 3 months after microblading procedure, you should notify/discuss with your doctor. Possible scarring may occur. I fully understand the information provided above & confirm that all information provided by me is correct and truthful. Sign below:   Signature*   Date*   

• I, First Name*   Last Name*   . am over the age of 18, am not under the influence of drugs or alcohol, am not pregnant or nursing and desire to receive the indicated semi - permanent pigmentation procedure. The general nature of cosmetic micro - pigmentation, as well as the specific procedure to be performed, has been explained to me.
• If an unforeseen condition arises in the course of the procedure, I authorize my technician to use her professional judgment to decide what she feels is necessary under the given circumstances. I accept the responsibility for determining the color, shape and position of the microblading/permanent makeup procedure as agreed during consultation. I fully understand and accept that non - toxic pigments are used during the procedure and that the result achieved may fade over a period of 1 - 3 years. Even once the color fades, pigment itself may stay in the skin indefinitely   
• I have been informed that the highest standards of hygiene are met and that sterile, disposable needles and pigment containers are used for each individual client, procedure and visit.
• I understand and accept that each procedure is a process may require multiple applications of pigment to achieve desired results and that 100% success cannot be guaranteed during the first procedure. I understand that I may have to return for a repeated procedure.
• The result of the procedure can be affected by the following: medication, skin characteristics (dry, oily, sun - damaged thick or thin skin type), personal pH balance of your skin, alcohol intake and smoking, post procedure after care.
• I understand that with oily skin types, strokes can heal less crisp, expanded and/or blurry and may result in a powder - brow effect.
• Upon completion of the procedure there might be swelling and redness of the skin, which will subside within 1 - 4 days. In some cases, bruising may occur. You may resume normal activities following the procedure , however, using cosmetics, excessive perspiration and exposure to the sun should be limited until the skin has fully healed. Please see after care instructions for more details. The procedure results will look acceptable for you to appear in public without additional make - up on the brows.
• I have been advised that the true color will be seen 6 weeks after each procedure, and that the pigment may vary according to skin tones, skin type, age and skin condition. I understand that some skin types accept pigment more readily and no guarantee on exact color can be given.
• To my knowledge, I do not have any physical, mental or medical impairment or disability that might affect my well - being as a direct or indirect result of my decision to have the procedure done at this time.
• I agree to follow all pre - procedure and post - procedure instructions as provided and explained to me by the technician. Failure to do so may jeopardize my chances for a successful procedure. I can confirm that I have received a copy of aftercare details.
• 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, 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 semi - permanent skin pigmentation procedure(s) and accept the permanence of this procedure as well as the possible complications and consequences of the said procedure   Initial here*   

I understand that if I have any skin treatments, injectables, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my microblading and/or tattoo procedure. I acknowledge some of these potential adverse changes may not be correctable   Initial here*   . 

I certify that I have read and initialed the above paragraphs and have had explained to my understanding the consent and procedure permit. I accept full responsibility for the decision to have this cosmetic semi - permanent pigmentation work done. I,   First Name*   Last Name* , give My Pretty Face Skincare Studio, LLC and it's employees permission to perform my microblading or permanent makeup tattoo procedure.   Signature*   Date*   

I hereby consent to, and authorize the use by My Pretty Face Studio of the specified microblading/eyebrow tattoo photographs and/or video; that is, photographs taken before, during and after my procedure.

I understand that my identity will be protected and neither my full face nor my name will be used in conjunction with the photographs and/or video.

My Pretty Face Studio has explained that all the photos and/or videos will be clinically appropriate and tastefully presented.

I have agreed on the photographs that My Pretty Face Studio requests to be used and it is understood that these photos may be used on My Pretty Face Studio's web site, social media accounts (Facebook, Instagram, Twitter, etc.), and in - office for demonstrative and promotional purposes.

I understand that I am not entitled to compensation for these photos being used.

Should I desire to revoke permission for their use in the future, I understand that I must notify My Pretty Face Studio in writing and allow 30 days to accomplish this removal.

I now release My Pretty Face Studio, and anyone authorized by My Pretty Face Studio, all personal rights and objections I have or may have to the above described uses of my photographs and/ or videos. I have entered into this release freely or voluntarily, and agree to be bound thereby.
Signature*   Date*