Model Consent Form
MODEL CONSENT
Heading
TO APPLICATION OF PERMANENT MAKEUP
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
WHAT SERVICE WILL BE PERFORMED TODAY?
*
Please Select
EYEBROWS
MICROBLADING
EYELINER
LIP COLOR
AREOLA
SCAR CAMOUFLAGE
VITILIGO
SCALP PIGMENTATION
The general nature of cosmetic tattooing as well as the specific procedure to be performed has been explained to me and I have read and signed an Informed Consent that explains and describes the benefits and any possible complications and contraindications.
*
I understand the taking of before and after photographs of said procedure(s) are required.
*
I am allowing my Trainee/Trainees to use a photo of only the area of the procedure performed for their education and to build their portfolio. This portfolio may include social media. Your identity is not obvious with close-up photos. For instance, this would be a close-up photo of your eyebrows, your eyeliner, your lips, your areola, your area of scar camouflage, etc.
*
I am allowing my Trainee/Trainees to photograph a larger area or a full face for a better representation of their work and for their portfolio. This portfolio may include social media.
*
I certify I have read the above paragraphs and have had explained to my full understanding this consent and procedure permit and I will not hold INSERT YOUR BUSINESS or Trainee(s) responsible for any unforeseen condition arising out of the indicated permanent cosmetic procedure.
*
Model Name
*
First Name
Last Name
Model Signature
*
Date
*
-
Month
-
Day
Year
Date
Apprentice Name
*
First Name
Last Name
Apprentice Signature
*
Date
*
-
Month
-
Day
Year
Date
Trainer Name
*
First Name
Last Name
Trainer Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Signature
*
Date
*
-
Month
-
Day
Year
Date
Should be Empty: