Permanent Makeup Consent + Release Form

Name*

First NameLast Name

Date of Birth*

Date

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Address*

Street Address

CityState / Province

Postal / Zip Code

Emergency Contact Name*

First NameLast Name

Emergency Contact Phone Number*

Please enter a valid phone number.

Do you have any of the following medical conditions? (Check all that apply)*

If any of the above apply, please list medications or details:

Are you currently taking blood thinners, aspirin, or any medications that affect healing?*

YesNo

Have your consumed alcohol, caffeine, or recreational drugs in the last 24 hours?*

YesNo

Have you had Botox, fillers, or other cosmetic treatments near the area in the last 2 weeks?*

YesNo

Are you currently pregnant or nursing?*

YesNo

Do you have any blood borne pathogens, transmittable diseases, or recent illnesses? *

YesNo

Permanent makeup is a form of tattooing where pigment is implanted into the skin. As with any cosmetic procedure, there are potential risks, including but not limited to:

Allergic reactions
Infection
Uneven or faded results
Swelling, redness, or irritation
Scar formation

I understand that multiple sessions may be required to achieve desired results and that final results depend on skin type, aftercare, and other factors beyond the artist's control.

Please check each statement to indicate your understanding:*

Voluntary Procedure - I am voluntarily undergoing a permanent makeup procedure and take full responsibility for the decision.Risks & Complications - I understand that permanent makeup is a form of tattooing and carries risks such as infection, allergic reaction, uneven results, scarring and dissatisfaction with the final outcome.Healing & Aftercare - I acknowledge that proper aftercare is essential for optimal healing and results. I will follow the aftercare instructions provided by Celestial Beauty, LLC.Touch-Ups & Fading - I understand that permanent makeup requires healing time and may need a touch up session (4-8 weeks post procedure) to perfect the results. Fading can occur due to skin type, lifestyle, sun exposure and other factors.No Guarantees - I acknowledge that results vary from person to person based on individual skin types, healing and pigment retention.Pre-Existing Conditions & Medications - I can confirm that I have disclosed all medical conditions, allergies, and medications to my artist.Legal Age Confirmation - I confirm that I am at least 18 years old and legally able to consent to this procedure.Liability Waiver - I release Celestial Beauty, LLC, and artist, Milly Morales-Perez from any liability related to the outcome of my permanent makeup procedure.

Photography Consent*

State Issued Photo ID *

Client Name (Printed):

First NameLast Name

Client Signature:

Today's Date

Date

Permanent Makeup Consent + Release Form

Health Questionnaire

Procedure Details and Risks

Aftercare and Maintenance

Acknowledgments and Consent

Client Signature