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CONSENT FORM FOR PERMANENT COSMETICS u,'N�irokp, I hereby request and consent to the application of permanent color and consent to have the following procedures performed by: 'lease circle any of the following that rnaa perta°n to you Eyeliner Eyebrows Lip liner Full lip color Scar camouflage Beauty mask Areola repigmentation Other please read and Ij�II rAi tiela1nir9 =tater nts� I understand that the process used to apply color is not a one-step process and requires subsequent visits to achieve desired results. I further understand the fee includes my first visit and ONE Perfecting visit. Maintenance touch-ups are scheduled as needed and may vary from six months to three years. Fees for maintenance visits, pigment replacements, and scar camouflage are based on any hourly fee. I understand that with time, pigment can (and will) fade and change color according to metabolism, skin type, medications, age, smoking, alcohol, sun exposure, Retin-A, and Glycolic acids. I acknowledge that no guarantees have been made to me concerning the results of this procedure and that the professional recommendation is a NATURAL LOOK. I understand the nature of the procedure and possible complications or adverse effects occur as a result of applied pigments. I fully understand this is a tattooing process; therefore it is NOT that may considered a science, but an art*. I N1S is A PF (Zf" AI�A ENT a QOc C -s,$ . I have received and acknowledged pry and post- procedure instructions, and agree to strictly adhere to such instructions. I accept responsibility for determining the color, shape, and position of the pigments that will be applied. I understand the actual color of the pigment may be modified slightly due to the tone & color of my skin, Tlw\IKSiG-ivt�rt�5 AWE iv OT Fb/.\ AppRoVpD ^IN,) }IE1�1-IM COi�ls`NC�Utt�IG�S AZA UNKNOWN. I understand that the taking of before and after photographs of procedures are required. : `r Th2lmnwn possible complications from miaopigmertation are: redoes, swelling, bruising, dry patches, and tenderness. it is no mal to lose approximately ??, of ti e mior during the healing process. After most procedures, Lhe color may appear be a shade mo dark; in e dzys,. it n;ay appear to be too iighL After 10 days, the color will sr-lovi more initially. it gill appear softer when completely healed, as the color will come from the dermal layer of the skin Lo the epidermal laser of the skin. In the even; of a CAT scan or an MR-, please inform you, physician of your Iron Oxide Permanent Cosmetics, as some pulling or burning sensation may occur daring the procedure. Client's signature• Date Practitioner signature• Date