Name *

First Name

Last Name

Phone *

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Please check the box with each statement confirming that you have read and agree.

Aftercare instructions have been explained to me and a written copy will be given to me to retain in my possession, which I will follow to the best of my ability. If I have questions I will call or email you.

I understand that a certain amount of discomfort is associated with this procedure and that swelling, redness and bruising may occur.

I understand that Retin A, Renova, Alpha Hydroxy and Glycolic Acids must not be used on the treated areas. They will alter the color.

I understand that sun, tanning beds, pools, some skincare products and medications can affect my permanent makeup.

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 for my explanation to you my desire for specific colors, shape and position of 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 may need to maintain the color with future applications and a touch up session within three months.

I acknowledge that the proposed procedure(s) involve risks inherent in the procedure and have possibilities of complications during and/or following the procedures such as: infection, misplaced pigment, poor color retention and hyper-pigmentation.

I have been quoted the cost of today's appointment, which includes one (1) touch-up within a three month period. There will be no refunds for this/these elective procedures