Client Consent Form - PMU & Tattoos

Client Consent Form - PMU & Tattoos
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Emergency Contact Name

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Medical Questionnaire
Do you have any of the following

DiabetesAnemiaPregnantBreast FeedingBotox / InjectionsAIDS / HIVBlood born diseasesTake blood thinnersHistory of MRSAHepatitis A,B,C,DCancer / TumorsTake Accutane acne medicationUse RetinolsAllergies to Metals, Food, Latex, chlorhexidine gluconate, isopropyl alcohol, ironoxides, etc.Tan booth/tanningEasy bleedingRecent chemical peelsOther
Microblading/Hybrid Brows/Tattoos What to Expect

Possible Risks, Hazards, Dangers or Complications
- Pain: You may experience discomfort and/or pain during this procedure.
- Infection: Infection is very unusual. The risk of infection and the Possibility of allergic reaction to the pigments/inks or other materials used. The areas treated must be kept clean, and only freshly cleaned hands should touch the areas. See “After Care” sheet for instruction on care for eyebrows.
- Uneven Pigmentation: This can result from poor healing, inflection, bleeding, or manyother causes. (For brows: Your follow-up appointment will likely correct any uneven appearance.)
- Asymmetry (brows): Every effort will be made to avoid asymmetry, but our faces are notsymmetrical so adjustments may be needed during the follow-up session to correctany unevenness.
- Excessive Swelling or Bruising: Some people bruise or swell more than others. Icepacks may help reduce the swelling. The swelling or bruising typically disappears in 1-5 days. Some people don't bruise or swell at all.
- MRI: Because pigments used in Permanent Cosmetic procedures contain inertoxides, a low level magnet may be required if you need to be scanned by an MRImachine. You must inform your MRI Technician of any tattoos or permanentcosmetics.
- *The alternative to these possibilities is to use traditional cosmetic and NOT undergo the Semi-Permanent Eyebrow procedure*
EMOTIONAL HEALING (Eyebrows ONLY):

The healing process isn’t limited to just physical healing.

Some people handle it completely fine and some people cry and wonder what in the world they did to their brows.

Just know IT. IS. COMPLETELY. NORMAL.

After your brows are done they get darker and more full for a while then start flaking off leaving them “patchy" and light.

Please, please don’t judge your brows until they are completely healed.

Even before your touchup they will still need some tweaking to make them perfect and this is normal.

As long as you follow the aftercare instructions to the letter you will have amazing results.

I only do 30% of the work, you do the rest! It’s all about the healing!

As always, please let me know if you have any questions.
Statement of consent

Please read carefully and sign below
- Aftercare instructions will verbally discussed. I may request the aftercare instructions before the procedure if needed.
- I understand that a certain amount of discomfort and pain is associated with this procedure, and that swelling, redness and bruising may occur.
- I understand the risk of infection and the possibility of allergic reaction to the pigments/ink or other materials used, and will not held the Tattoo Artist accountable for any of the things mentioned above.
- I understand that Retin A, Renova, Alpha Hydroxy and Glycol Acids must not be used on the face before Microblading. They will alter the color and cause premature exfoliation of the pigment.
- I understand that tanning beds, pools, some skin care products and medications can affect my permanent makeup/tattoo.
- I understand that successful color saturation can NOT be guaranteed due to hidden scar tissue or other factors.
- I will tell all skin care professionals or medical personnel about my permanent makeup procedures, especially if I am scheduled for an MRI.
- I accept the responsibility to explain to you by desire for specific colors, shape, and position for any procedure done today.
- I understand that implanted pigment color can slightly change or fade over time due to circumstances beyond your control, and I will need to maintain the color with future applications and a touch-up session within 40 days.
- I acknowledge that the proposed procedures involve risks inherent in the procedure, and have possibility of complications during and/or following the procedures such as: inflection, misplaced pigment, poor color retention and hyper-pigmentation.
- I have been advised that a touch-up session is mandatory for brows, to make any adjustments to shape, color, and to fill any pigment that may have had poor retention. Touchups must be completed within 40 days of initial procedure or I will need to pay full price.
- I have been quoted the cost of today’s appointment, and the cost of the touch-up. Touchups must be completed within 40 days of initial procedure to be considered touch-up price.
- I will not held anyone besides myself accountable for unproper healing, infections, or possible complications with my results.
- I understand that Vera is a professional and licensed tattoo artist.
- I release BellaBrow by Vera Esthetics of all and any liability.
I certify that I have read or have had read to me the contents of this form. I understand the risks and alternatives involved in this procedure(s). I have had the opportunity to ask questions, and all of my questions have been answered. I acknowledge that I have reviewed and approved the material given to me and I authorize Vera, as my PMU technician and tattoo artist to perform on my body the 3D Eyebrow Microblading, Hybrid Brows, or tattoo procedure desired today. Please sign below:

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Client Consent Form - PMU & Tattoos

Medical Questionnaire

Microblading/Hybrid Brows/Tattoos What to Expect

Statement of consent