For Diabetic clients only.

I confirm that my diabetes and blood sugar levels are stable and under control at the time of having my permanent makeup procedure done. I have had medical approval from my Doctor who has confirmed I am able to have this procedure carried out. 

(please sign below)

This form is designed to give information needed to make an informed choice of whether or not to undergo permanent makeup treatment. If you have any questions please do not hesitate to ask. 

Although permanent makeup is effective in most cases, no guarantee can be made that a client will benefit from the procedure.

Permanent makeup is a process of inserting pigment into the very top layer of your dermis. It is a form of tattooing, but the pigment is semi-permanent. 

All instruments that enter the skin or come into contact with body fluids are disposible, and disposed of after use. Cross contamination guidelines are strictly adhered to. 

Generally the results are excellent. However, a perfect result is not a realistic expectation. It is usual and advised to have a touch up done after healing is complete. 

Initially the colour will appear more vibrant or darker than the end result. Usually within 5-7 days the colour will have faded by 40-50%, soften and look more natural. 

The pigment is semi-permanent and will fade over time. Additional touch ups are likely to be needed within 1 to 2 years. How quickly the pigment fades will be different for each individual and relies on many factors such as metabolism, skin type, medication, skincare, sun exposure, lifestyle choices & aftercare. 

CONSENT

• I certify that I am over the age of 18, and not under the influence of drugs or alcohol.
• I confirm that all information given in this form is true, complete, and accurate.
• I release this organisation of any responsibility in case of accident, illness, or injury.
• I understand that this cosmetic procedure is not fully permanent and will result in fading over time.
• I realise that patchy results can be normal after my initial permanent makeup procedure, which is why I am recommended to have a touch-up appointment 4-8 weeks after my first appointment. I understand that if I choose to not have the touch-up appointment within the 4-8 week time frame my results may not last as long or look as good. I understand that the process used to apply colour is not a one step process. I further understand that the fee includes my first visit and one touch-up visit within 8 weeks of first appointment and the result of the procedure will be a permanent change.
• I understand that topical anesthetics are used to numb the area to be tattooed. Lidocaine, Prilocaine, Benzocaine, Tetracaine, and/or Epineohtine cream and/or liquid are used. If you are allergic to any of these please inform me now in the box below.
• I understand that a certain amount of discomfort is associated with this procedure. There can be pain even after the topical anaesthetic has been used as anaesthetics work better on some people then others. Anaesthetic is applied before we start the lip blush and eyeliner lash line enhancemant procedure, however it is not applied for the first pass for microblading as this will result in the microbladed hair strokes not being crisp. It is applied to the skin before the second pass of microblading.
• I understand that some swelling and bruising may occur. However this is extremly rare. Some people bruise or swell more than others. Ice packs may help reduce any swelling.
• I understand the nature of the procedure and possible complications, reactions or adverse effects that may occur as a result of the applied pigments. I fully understand this is a tattooing process, and have discussed any medical conditions.
• I acknowledge that no assurance was offered about the outcome. I have read through the Frequently Asked Questions on Becky Gough's website, and through the precare and aftercare advice sent to me on text messages. I agree to strictly adhere to these instructions and any adverse effects due to my failure to adhere to the instructions shall solely be my responsibility.
• I understand that photographs taken for comparison of the before and after procedure are part of the procedure and allow Becky Gough to use the photos for marketing or promotional services.
• I accept full responsibility for the decision to have this permanent makeup procedure done.  
• I have received a patch test for the pigment/or I waive my right to having the patch test against advice. I release the therapist from liability should I have an allergic reaction.
• I acknowledge by signing below, that I have been given the full opportunity to ask any and all questions about this procedure(s) from Becky Gough. I also acknowledge that all of my questions have been answered to my full and total satisfaction.