Permanent Makeup Consent and Disclosure & Release Form
Please review and complete all sections to provide your informed consent and release for permanent makeup procedures at Ink Beautiful The Lounge.
Consent Form Date and Time
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Hour Minutes
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PM
AM/PM Option
I acknowledge and understand the following:
In consideration of receiving a tattoo or permanent make up service at INK BEAUTIFUL THE LOUNGE from (artist name).*
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Artist- First & Last Name
That I (clearly PRINT your name) have been fully informed of the inherent risks and dangers associated with getting a tattoo/PMU Service.
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Client- First & Last Name
1. I have been informed of the nature, risks, and possible complications of permanent makeup procedures, including but not limited to infection, allergic reaction, scarring, inconsistent color, and dissatisfaction with the results.
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I understand and accept.
2. I have received and fully understand the aftercare instructions and agree to follow them as directed.
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I understand and accept.
3. I understand that I am responsible for any medical care costs that may arise as a result of this procedure.
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I understand and accept.
4. I acknowledge that there is a risk of injury and agree that Ink Beautiful The Lounge and its artist/technicians are not liable for any injuries sustained.
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I understand and accept.
5. I understand that color and outcome may vary depending on skin type, lifestyle, and other factors.
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I understand and accept.
6. I understand that permanent makeup is a form of tattoo and that pigment may not fully fade over time.
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I understand and accept.
7. I understand that results are not guaranteed and may require additional procedures or touch-ups.
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I understand and accept.
8. I waive all claims for damages, including allergic reactions, skin sensitivities, or failure to follow aftercare instructions.
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I understand and accept.
10. I confirm that I am at least 18 years of age and am signing this consent form voluntarily.
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I understand and accept.
9. I declare that I have disclosed all relevant medical history and will inform Ink Beautiful The Lounge of any future changes.
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I understand and accept.
Please initial each statement below to indicate your understanding and agreement:
1. I have truthfully and accurately completed this form and disclosed all information requested by Ink Beautiful The Lounge.
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2. I understand that withholding information may increase risk of complications.
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3. I acknowledge that permanent makeup is a form of tattooing and that results may vary.
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4. I understand that some individuals may have adverse reactions to pigment, anesthetics, or aftercare products.
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5. I agree to follow all pre- and post-procedure instructions provided to me.
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6. I understand that multiple sessions may be required to achieve desired results.
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7. I acknowledge that pigment color may change or fade over time.
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8. I understand that touch-ups may be necessary to maintain results.
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9. I understand that there are risks of infection, scarring, and dissatisfaction with the outcome.
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10. I release Ink Beautiful The Lounge and its artist/technicians from any liability related to this procedure.
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11. I understand that photographs may be taken for documentation and consent to their use.
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12. I confirm that I am not under the influence of drugs or alcohol at the time of this procedure.
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13. I have been given the opportunity to ask questions and have received satisfactory answers.
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14. I understand that no refunds will be given once the procedure has begun.
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15. I acknowledge that I am responsible for the cost of any medical care that may result from this procedure.
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16. I understand that results are not guaranteed and may be affected by individual factors.
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17. I confirm that I am at least 18 years of age.
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18. I agree to notify Ink Beautiful The Lounge & Artist/Technician giving service, of any changes to my medical history before future procedures.
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I acknowledge that payment is taken prior to treatment and that full payment is due even if the treatment is stopped.
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I acknowledge and accept.
I agree that this agreement remains in effect for this procedure and all future follow-up appointments, and that a new consultation is required if my medical history changes.
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I agree and accept.
I confirm that I have read and fully understood this agreement and that I am over 18 years of age.
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I confirm and accept.
I agree to reimburse both artist and Ink Beautiful The Lounge for any attorneys' fees and costs incurred in any legal action I bring where either the artist/technician or Ink Beautiful The Lounge is the prevailing party. I agree that the courts shall have personal jurisdiction and venue over me and shall have exclusive jurisdiction for the purpose of litigating any disputes arising from related to this agreement.
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I confirm and accept.
Client Print Name
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Client Signature
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Client Signature Date
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Submit Consent & Release
Submit Consent & Release
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