Lip Blush PMU Consultation and Waiver Form

  • Client Consultation Form

  • Personal/Medical History Form

    To ensure you receive the most appropriate Lip Blush PMU treatment, please complete the following questionnaire. All information provided will remain strictly confidential.

  • Date of Birth*
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  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • How did you hear about us*

  • Medical History

  • Do you or have you ever regularly sunbathed or used tanning salons?*
  • Do you smoke?*
  • Have you previously had micropigmentation performed on the exact area where I will be working on by another professional?*
  • Do you have any Lip fillers, Botox, or other injectables in the last 30 days?*
  • Are you currently under the care of a physician for management of an illness or condition?*
  • Rows
  • Do you have any other health problems or medical conditions not listed above?*
  • Have you ever had an allergic reaction to any food, drug, or environment source?*
  • Are you pregnant or trying to become pregnant?*
  • Are you breastfeeding?*
  • Do you have a history of, or currently experiencing epilepsy or seizures?*
  • Are you on any blood-thinning medications or immunosuppressive drugs, such as aspirin?*
  • Do you participate in outdoor recreational activities?*
  • Have you used Accutane or been treated for acne in the past year?*
  • Do you use skincare products with Retin-A, Retinols or Vitamin A?*
  • Do you have any known allergies to lidocaine, numbing agents, or pigments?*
  • Have you had any facial procedures done in the last 30 days?*
  • Have you had permanent makeup or other cosmetic tattoo procedures before?*
  • Have you had any recent medical procedures?*
  • Do you have any chronic medical conditions?*
  • Do you currently have any blemishes, cuts, irritation, or infections on the area to be treated?*
  • Do you have any moles, raised areas, prior or current piercings in the projected procedural area?*

  • LIP BLUSH CONTRAINDICATIONS

  • A contraindication is a condition or factor that may make a client unsuitable for Lip Blush PMU due to health risks or the possibility of adverse outcomes. Please consult with your technician before the procedure if any of the following apply to you:

    Not Recommended for Clients Who Are or Have:

    • Open wounds, cuts, abrasions, burns, or active skin conditions
    • Active cold sores / herpes simplex outbreak
    • Pregnancy (most artists avoid entirely due to liability + numbing agents)
    • Uncontrolled diabetes
    • Bloodborne diseases that are unmanaged (high infection risk)
    • Open wounds, cuts, or infections on the lips
    • Severe skin conditions on lips (active dermatitis, infection)
    • Recent lip surgery (not fully healed)
    • Known allergy to pigments or numbing agents
    • Current use of Accutane (isotretinoin) or within the last 6–12 months
    • Keloid scarring tendency (strong history)Contraindications Requiring Extra Caution
    • Autoimmune diseases affecting skin
    • Skin medications or treatments that thin or irritate the skin
    • Post-chemotherapy recovery (must be medically cleared)
    • Rosacea or similar chronic skin conditions near the brows
    • Those who are allergic to Red Lake #5 (synthetic food dye) 

     

    Please disclose any medical conditions, allergies, or recent procedures to your technician prior to your appointment. Your safety and the effectiveness of the treatment depend on accurate and honest communication.

  • AFTERCARE

  • LIP BLUSH PMU AFTERCARE INSTRUCTIONS
    Aftercare is essential for maintaining the appearance and longevity of your new Lip blush, please read the following Lip Blush aftercare instructions carefully!

    • Avoid direct sun exposure and wear SPF daily for at least 72 hours
    • Do not wear makeup for 6–12 hours after treatment
    • Avoid exfoliants, retinols, or active acids for 3–5 days
    • Do not use hot water; cleanse with lukewarm water only for 24 hours
    • Avoid sweating, saunas, hot tubs, or intense exercise for 24–48 hours
    • Keep your skincare simple—use only gentle cleanser and moisturizer
    • Avoid waxing, threading, or facial hair removal for 48–72 hours
    • Do not swim in chlorinated or saltwater pools for at least 48 hours
    • Do not pick, scratch, or rub your face post-treatment
    • Do not let any water, lotion, soap, or makeup touch your eyebrows area during the first 7 days after your procedure.
    • Please wash your face carefully around the eyebrow without getting water on the treated area. During the shower, keep your face away from the shower head or take a bath.
    • Itching and flaking may appear during the first seven days post procedure. Avoid picking or scratching as it can pull off scabs prematurely and cause patchy results or scarring. However, experience has shown that by following these after-care instructions, these symptoms may quickly disappear.
    • After four days, ensure your hands are completely clean before gently applying the post-care ointment with a cotton swab. This should be done twice a day, in the morning and at night, but use the ointment sparingly, as your skin needs to heal naturally. Continue applying the ointment for seven days.
    • The following must be avoided during all 14 days post procedure:
    • Increased sweating
    • Practicing sports
    • Swimming
    • Sun tanning or salon tanning
    • Hot sauna, hot bath, or Jacuzzi
    • Exposure to UV/UVA Rays or chemicals as they have been known to cause a shift in color and premature fading
    • Any laser or chemical treatments or peelings, and/or any creams containing Retin-A or Glycolic acid on the treatment area
    • Picking, peeling, or scratching of the micro pigmented area in order to avoid scarring of the area or removal of the pigment
    • Performing tasks related to heavy household cleaning such as garage or basement cleaning where there is a lot of airborne debris
    • Avoid sleeping on your face: For the first 10 days, try not to sleep on your eyebrows to prevent unnecessary pressure and friction, which may interfere with the healing process
    • Avoid excessive facial expressions: Minimize exaggerated facial movements, especially during the first few days of healing. Excessive stretching or movement of the skin can affect healing and pigment retention
    • Be cautious with makeup: After the initial healing period (approximately two weeks), you may apply makeup around your eyebrows. However, avoid applying makeup directly to the treated area for at least 14 days to allow the skin to fully heal
    • Use a clean pillowcase: Change your pillowcase every 2–3 days to reduce the risk of bacteria or dirt coming into contact with your healing eyebrows
    • Avoid aggressive exfoliation: For at least 30 days post-procedure, avoid using exfoliating products or treatments on the brow area. This includes physical scrubs and products containing AHA/BHA, as they may cause premature fading or irritation
    • Stay hydrated: Proper hydration supports the body's natural healing process, so drink plenty of water during recovery
    • Drinking alcohol in excess, as it may lead to slow healing of wounds
    • Driving in open air vehicles such as convertibles, boats, bicycles, or motorcycles
    • Touching the eyebrow area except for when rinsing and applying the post-care cream with a cotton swab
    • Inform your nurse before giving blood, as the procedure may affect donation eligibility
    • Inform your therapist before a chemical peel or other medical procedure, as these should only be done after the healing process is complete.
    • Contact a physician if any signs or symptoms develop such as the following: fever, redness at the site, swelling, tenderness of the procedure site, elevated body temperature, red streaks going from the procedure site towards the heart, and/or any green/yellow discharge that is foul in odor.

  • WHAT TO EXPECT DURING AND AFTER YOUR LIP BLUSH SESSION

    The entire healing process will take from 4–6 weeks depending on your body’s regeneration and age. Your lips will go through several phases during the healing cycle.

    The pigment will appear very bright and intense immediately after the procedure. The color may look darker and more saturated the next day.

    Note that because of natural skin regeneration, after the recovery period (peeling), the lips might appear much lighter than the original color. This may give the impression that the color has faded too quickly. In most cases, the color will gradually return as the lips fully heal. It is also normal for some areas to heal unevenly or patchy. That is why most clients require a touch-up after 6–8 weeks.

    Once the healing process begins, your lips may feel dry and start to flake or peel. This can resemble dry or chapped lips. This is only superficial pigment and dry skin naturally shedding. Do not pick, peel, or rub the lips, as this can affect retention and cause uneven results.

    You may experience mild swelling, tenderness, and sensitivity for the first 24–48 hours.

    Avoid spicy, hot, or acidic foods during the initial healing days, as well as excessive water exposure such as swimming, saunas, or heavy sweating.

    Keep the lips clean and consistently moisturized with the recommended aftercare product.

    The final healed results will be visible approximately 4 weeks after your procedure.

    Once completely healed, applying SPF on the lips will help preserve the pigment and prevent premature fading.

    When using makeup, avoid applying products directly on healing lips. Once healed, certain lip products may alter the appearance of your lip blush.

    You can now enjoy your beautifully enhanced lips and a soft, natural flush of color!

  • HEALING PROCESS – LIP BLUSH

    RIGHT AFTER – Lips will appear bright, bold, and more intense in color. Swelling and redness are normal and can vary for each individual. Lips may feel tender, tight, and slightly uneven. Keep lips clean, avoid touching, and follow aftercare instructions.

    DAY 2–3 – Lips may still feel dry and tight. Color remains bold. Avoid excessive moisture, spicy or acidic foods, and keep lips protected.

    DAY 3–5 – Lips will begin to peel and flake, similar to dry or chapped lips. Do not pick, peel, or rub, as this can cause uneven healing and pigment loss.

    DAY 5–7 – Peeling continues and lips may start to look lighter or patchy. This is normal. Continue applying a thin layer of recommended aftercare ointment to keep lips hydrated.

    DAY 7–10 – Most of the peeling is complete. Lips may appear very light or as if color has disappeared. This is part of the healing process.

    DAY 10–14 – Lips are healed on the surface and feel more normal. You may return to regular activities, but continue to keep lips moisturized.

    WEEKS 3–6 – Color will gradually resurface and deepen as the skin fully heals. Final color results become more visible during this time.

    DAY 40 – Lips are fully healed. Final color has settled and evened out. Now enjoy your healed lip blush results!

    Clients will require a touch-up appointment to perfect the color, shape, or any uneven areas.

  • ACKNOWLEDGMENT

    LIP BLUSH CONSENT FORM AND RELEASE FORM

  • Please read each statement carefully. By checking each box, you confirm that you understand and agree to the statement.

  • I,       confirm that I am over 18 years of age, not under the influence of drugs or alcohol, and not pregnant or nursing. I voluntarily wish to receive the semi-permanent makeup (PMU) procedure.*
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    • Sun Damaged Skin will always heal cool and may not be able to be warmed up regardless of color chosen.
    • Use of products with alpha-hydroxy acids (AHA), glycolic acids or retinol etc will cause the pigment to fade faster even if not applied directly to the treated area.
  • Date*
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