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Waiver, Release, and Consent to Microblading <br /> pleasea certain you understand the implications of alp <br /> This document is two pages please initial each provision on the lines provided after reading to <br /> show that you understand each provision <br /> In consideration of receiving permanent -up from Shaunessey Fredericksen at The Raven <br /> Tattoo&art Gallery(together with its employees,apprentices andagents),I agree to the <br /> following: <br /> It has been explained to me that the pwedure to be used is reftmad to as Micro-pigmentation. <br /> (the process of implanting mioro-deposits of pigment into the apidermoal layer of the skin).Micro- <br /> pigment Implantation is a form of tattooing used for the purpose of permanent cosmetic makeup <br /> and skin imperfection camouffage or tattoo removal. <br /> I realize the procedure will probably result in permanent and irreversible color change in the skin <br /> area treated.However rate,some of possible complications resulting from this procedure may <br /> include infection, scarring,swelling, bruising,numbness,and post procedure discomfort,allergic <br /> reaction to one of the pigments or anesthetic agents(topical or oral) <br /> I understand that the practice of this procedure is not an exact science.Colors may not mach <br /> perfectly or appear exactly as expected.Over the months and years following the procedure, <br /> softening,fading or changing of color of the pigment may occur <br /> I understand that there isa possibility of Hyper-pigmentation resulting from a procedure. <br /> I have been told that this procedure will most likely involve some pain and discomfort. <br /> I understand that no warranty or guarantees have been made to me as to the result of the <br /> procedure. <br /> I understand that there will be before and after photos taken.Photos will be posted to Instagram <br /> and Facebook. <br /> I have been given the opportunity to ask questions about the procedure and the risk involved. <br /> Full amount is due at the beginning of service.Payment due in cash or card NO REFUNDS NO <br /> EXCEPTION. <br /> I'understand that the description of the procedure is not meant to scare or alarm me.It describes <br /> the procedure to be utilized so i may make an h-Abmed decision to proceed or refuse the <br /> procedure.In consideration of having a service provided by Shaunessey Fredericksen,I fully <br /> release and discharge Shaunessey Fredericksen(hereafter referred to as Shaunessey <br /> Fredericksen)without limitation,from any and all claims,losses,demands,rights of cause of <br /> action,damages or injuries to my person or property,present or future,whether known, <br /> anticipated or unanticipated,that may occur from any cause whatsoever,whether based on tort, <br /> contract,product liability,or other theory of recovery,as a result of or arising out of any <br /> treatment or surgery that may anise from any treatment or procedure by Shaunessey <br /> Fredericksen,including,but no limited to,any claims for known,unknown,latent,developed,or <br /> undeveloped injuries,anticipated and unanticipated consequences,and known and unknown <br /> developments of any such injuries and claims with respect to the nature,extent,and permanency <br /> of any such injuries. <br /> Signature: Date: <br /> I understand that I might need to a 6 week touch up and all touch am by appointment <br />