Permanent Makeup Consent Form
Client Name
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First Name
Last Name
Date of Birth
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Month
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Day
Year
Date
Are you currently over the age of 18?
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Yes
No
Email address:
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Phone number:
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Home Address:
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Street Address
Street Address Line 2
City
State
Zip Code
Emergency Contact Information:
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How did you hear about Monarch Studios?
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What service are you interested in?
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Are you currently pregnant or breastfeeding?
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Yes
No
Are you taking any blood thinners?
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Yes
No
List any and all medications you take consistently and within the last 2 weeks:
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List any allergies:
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List any conditions/illnesses:
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Do you have diabetes?
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Yes
No
Do you have hemophilia and/or a bleeding disorder?
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Yes
No
Do you have a heart condition?
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Yes
No
Do you have an autoimmune disorder?
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Yes
No
Are you currently on your menstrual cycle?
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Yes
No
Are you or have you been on antibiotics within the past 2 weeks?
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Yes
No
I give Monarch Studios permission to use my before + after photos for marketing purposes.
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Yes
No
I will discuss my desired results with my artist and we will agree on a shape, color and procedure together.
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Yes
No
I understand that permanent cosmetics/tattoos alter my appearance. To my knowledge, I do not have any impairment which affects my decision-making skills.
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Yes
No
Have you had any reactions to numbing creams in the past?
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Yes
No
I understand that if I have any signs/symptoms of infection, I will seek medical attention immediately. These signs are including, but not limited to: redness, swelling, tenderness at the site, elevated temperature, etc.
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Yes
No
Have you had any facial plastic surgery in the last 12 months?
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Yes
No
Have you received any botox or filler? It is recommended that you wait a minimum of 2 weeks (4 weeks for filler) before a PMU procedure.
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Yes
No
Are you currently using retinol/retinoids? It is recommended that you stop using these for 2 weeks before your procedure.
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Yes
No
Are you on Accutane or any prescription acne medication? It is recommended to be off of these for a minimum of 12 months before permanent makeup procedures.
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Yes
No
I understand that pigment works differently in various skin types. Clients with oily/acne-prone skin, large pores, thin or sensitive skin have more difficulty holding pigment.
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Yes
No
I have not received a facial, chemical peel, laser treatment in the last 4 weeks. I understand that my skin needs to heal before receiving any permanent makeup procedure.
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Yes
No
I understand that I must NOT tan my skin for at least 2 weeks prior to/after my procedure. I understand that my skin will not hold pigment evenly. I understand that I am not able to receive this procedure if my skin is sunburnt.
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Yes
No
I understand that I must avoid the following within the 24 hours prior to my appointment: alcohol, caffeine, vitamin e, aspirin, fish oil supplements, strenuous exercise, or blood thinners (48 hours).
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Yes
No
I understand that successful color saturation cannot be 100% guaranteed. I understand that certain elements can alter the color of my PMU, i.e, sun exposure, sun tanning, laser procedures, chemical skin treatments, etc.
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Yes
No
I understand that my pigment can slightly change in color and/or shape and that it will fade over time due to circumstances beyond the control of my artist. I understand that I will need to maintain my desired results at my own expense.
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Yes
No
I understand that not all skin types hold pigment the same way and my results will not mirror anyone else's.
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Yes
No
I understand that I need to make my skin professionals aware of my permanent makeup, so they can adjust their procedure accordingly.
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Yes
No
I understand the not following pre-care or aftercare can result in forfeiting my appointment and paying a fee for day-of cancellation.
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Yes
No
I understand that any touchup appointment will need to be made within 9 weeks of my initial service. Appointments made after this time period will result in additional expenses.
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Yes
No
Permanent Makeup Aftercare Instructions:
After the procedure, with clean hands, I will use a wet cotton round to wipe away any lymph fluid or blood that secretes from the affected area. I will continue this every hour for the first 24 hours and will not allow any fluid to harden.
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Yes
No
I will wash my tattoo once a day with a mild, natural soap (included in aftercare kit). With clean hands, I will wet and cleanse the are. I will avoid acne cleansers, astringents, washcloths, or sponges.
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Yes
No
I will allow my tattoo to air dry before applying my ointment.
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Yes
No
I will apply A&D/Aquaphor ointment with a q-tip; use sparingly. I will apply the ointment whenever I feel dry.
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Yes
No
I will not scrub, pick, rub the affected area. I will allow the tattoo to flake on its own.
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Yes
No
Around days 3-7, the darkness will fade, swelling will go down, and unevenness will disappear.
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Yes
No
As the area heals, the color will lighten and seem to disappear; this is completely normal. We are unable to address any issues until the 6 week mark after the procedure.
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Yes
No
I will book a touchup appointment around week 6-8 after my initial procedure. Maintenance may be needed every 12-24 months to keep up the shape and color.
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Yes
No
I WILL AVOID: Pools, saunas, steam rooms, hot showers and/or hot baths for 3 weeks; Sweating for a full 10 days; Sleeping on the affected area for 10 days; Letting my hair rest on the affected area; Makeup & skincare products on the area for 10-14 days; Facials, chemical treatments, retinol, laser treatments and microdermabrasion for 4 weeks; Botox for 4 weeks in the treated area; Direct sun exposure for 3 weeks; Eyebrow tinting for 2 weeks.
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Yes
No
I WILL EXPECT: Losing 30-40% of my pigment during the healing process; Changes in color; Flakiness; Tenderness 1-2 days after the procedure; Healing taking up to to 30 days; Booking a touchup in 6-8 weeks.
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Yes
No
I understand my tattoo consent form & aftercare instructions.
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Yes
No
I understand the risks that come with permanent makeup procedures.
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Yes
No
Preferred date of Service: (Sundays ONLY)
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Year
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Date of Signing:
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Month
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Enter full name to sign consent form.
Submit
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