• Ombré Powder Brows Consent Form

    Please review and complete the form to give your consent for the procedure.
  • Format: (000) 000-0000.
  • Are you currently under the care of a physician?*
  • Do you have any known allergies? (latex, pigments, numbing agents, etc.)*
  • Do you have a history of allergic reactions to cosmetics or tattoos?*
  • Medical History
  • Have you had previous permanent makeup or tattoos in the area?*
  • Have you had any of the following in the last 4 weeks?
  • Are you currently using any of the following?

  • Lifestyle Factors

  • Do you smoke?*
  • Do you consume alcohol regularly?*
  • Are you frequently exposed to the sun or use tanning beds?*
  • Are you pregnant or nursing?*
  • Are you currently menstruating?*
  • RISKS & POSSIBLE COMPLICATIONS I understand that possible risks include but are not limited to: Redness, swelling, tenderness, or bruising Infection Allergic reactions, Uneven pigment retention, Premature fading or Dissatisfaction with shape or color. Need for additional touch-up sessions, I acknowledge that no guarantees or warranties have been made regarding the final outcome of this procedure. Information commonly included in PMU consent documentation emphasizes informed consent, medical disclosure, risks, and aftercare responsibilities.
  • CLIENT RESPONSIBILITIES I confirm that: I am at least 18 years old. I have disclosed all medical conditions and medications accurately. I am not under the influence of drugs or alcohol. I have had the opportunity to ask questions regarding the procedure. I understand the pre-care and aftercare instructions provided to me.
  • LIABILITY RELEASE I understand that every precaution will be taken to ensure my safety and satisfaction. I knowingly and voluntarily assume all risks associated with this procedure. I hereby release, indemnify, and hold harmless RealizeBeauty6, its owner, employees, contractors, and representatives from any claims, damages, injuries, liabilities, costs, or expenses that may arise directly or indirectly from this procedure, except in cases of gross negligence or willful misconduct.
  • I voluntarily request and consent to the Ombre Powder Brow procedure, which is a form of semi-permanent cosmetic tattooing designed to enhance the appearance of my eyebrows. I understand and acknowledge: Results vary from person to person. Multiple sessions may be required to achieve desired results. A touch-up appointment is typically recommended. Pigment color may appear darker immediately after the procedure and will soften during healing. Healing results cannot be guaranteed due to individual skin types, lifestyle, medications, and aftercare compliance. The procedure involves the implantation of pigment into the skin using a cosmetic tattoo device.
  • I authorize RealizeBeauty6 to take before-and-after photos/videos of my procedure for documentation, portfolio, social media, marketing, and promotional purposes. I understand that my personal information will remain confidential and that I will not receive compensation for the use of these images.*
  • Date*
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