COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

I AGREE TO RELEASE AND FOREVER DISCHARGE,AND HOLD HARMLESS,THE TECHNICIAN,ALL EMPLOYEES, CONTRACTORS,AND THE MANAGEMENT OF THE PERMANENT MAKE-UP STUDIO, DREAMSCAPE BROWS LLC, FROM ANY AND ALL CLAIMS OF NEGLIGENCE, DAMAGES,OR LEGALACTIONS ARISING FROM OR CONNECTED IN ANY WAY WITH MY TATTOO,THE PROCEDURE,AND CONDUCT USED IN MY TATTOO AND ASSUME ALL RESPONSIBILITY FOR THE DECISION(S) MADE CONSENTING TO THIS PERMANENT PROCEDURE. I AM AWARE THAT TATTOO INKS, PERMANENT COSMETIC INKS, DYES,AND PIGMENTS HAVE NOT BEEN APPROVED BY THE FEDERAL FOOD AND DRUG ADMINISTRATION AND THATTHE HEALTH CONSEQUENCES OF USING THESE PRODUCTS ARE UNKNOWN. VARIATIONS IN COLOR AND DESIGN MAY EXIST BETWEEN THE TATTOO ART I HAVE SELECTED AND THE ACTUALTATT00 WHEN IT IS APPLIED TO MY BODY. I ALSO UNDERTAND THAT OVER TIME,THE COLORS AND THE CLARITY OF MY TATTOO WILL FADE DUE TO UNPROTECTED EXPOSURE TO THE SUN AND THE NATURALLY OCCURRING DISPERSION OF PIGMENT UNDER THE SKIN, A TATTOO IS A PERMANENT CHANGE TO MY APPEARANCE AND CAN ONLY BE REMOVED BY LASER OR SURGICAL MEANS,WHICH CAN BE DISFIGURING AND/OR COSTLY AND WHICH IN ALL LIKELIHOOD WILL NOT RESULT IN THE RESTORATION OF MY SKIN TO ITS EXACT APPEARANCE BEFORE BEING TATTOOED. I UNDERSTAND I WILL HAVE PERMANENT MAKE-U P,ALSO KNOWN AS COSMETIC TATTOO, APPLIED USING APPROPRIATE INSTRUMENTS AND STERILIZATION TECHNIQUES. I UNDERSTAND THAT THE PERMANENT MAKE-UP SITE USUALLY TAKES 2 WEEKS OR LONGER TO HEAL. I UNDERSTAND THIS IS ATATTOO PROCESS AND THEREFORE NOT AN EXACT SCIENCE, BUT AN ART. 1 REQUESTTHE PERMANENT MAKE-UP PROCEDURE AND ACCEPT THE PERMANENCE OF THE PROCEDURE AS WELL AS THE POSSIBLE COMPLICATIONS AND CONSEQUENCES OF THE SAID PROCEDURE. I UNDERSTAND THAT WHILE THIS IS SOMETIMES REFERRED TO AS SEMI-PERMANENT IN NATURE, DUE TO EACH INDIVIDUAL'S REACTION TO PIGMENT,THE LENGTH OF TIME PIGMENT IS PRESENT CANNOT BE GUARANTEED. IN SOME CASES, PIGMENT WILL BE PERMANENT. I ACKNOWLEDGE INFECTION IS ALWAYS POSSIBLE AS A RESULT OF TATTOO OR PERMANENT MAKE-UP APPLICATION. I HAVE RECEIVED PRE-AND POST-PROCEDURE INSTRUCTIONS AND I UNDERSTAND THEM AND WILL STRICTLY ADHERE TO SUCH INSTRUCTIONS. I UNDERSTAND THAT MY FAILURE TO DO SO MAY JEOPARDIZE MY CHANCES FOR A SUCCESSFUL PROCEDURE. I AGREE THAT IT IS MY RESPONSIBILITY TO CONTACT MY TECHNICIAN IF THERE ARE ANY SIGNS AND SYMPTOMS OF INFECTION, INCLUDING, BUT NOT LIMITED TO REDNESS, SWELLING,TENDERNESS OF THE PROCEDURE SITE, RED STREAKS GOING FROM THE PROCEDURE SITE TOWARDS THE HEART, ELEVATED BODY TEMPERATURE,OR PURULENT DRAINAGE FROM THE PROCEDURE SITE. I UNDERSTAND THATTHE TAKING OF BEFORE AND AFTER PHOTOGRAPHS OF THE SAID PROCEDURE ARE A CONDITION OF SUCH PROCEDURE. I RELEASE ALL RIGHTS TO ANY PHOTOGRAPHS TAKEN OF ME AND THE PERMANENT MAKEUP OR TATTOO AND GIVE CONSENT IN ADVANCE TO THIS PERMANENT MAKE-UP STUDIO TO USE IMAGES OF MY TATTOO(S) FOR MARKETING AND, OR PUBLISHING PURPOSES IN VARIOUS MEDIA SUCH AS THE INTERNET, MAGAZINE, PRINTED,AND OR TELEVISION ETC. I UNDERSTAND THAT IF I HAVE ANY SKIN TREATMENTS, LASER HAIR REMOVAL, PLASTIC SURGERY OR OTHER SKIN ALTERING PROCEDURES, IT MAY RESULT IN ADVERSE CHANGES TO MY PERMANENT COSMETICS. I ACKNOWLEDGE SOME OF THESE POTENTIAL ADVERSE CHANGES MAY NOT BE CORRECTABLE. I AM NOT PREGNANT OR NURSING. I DO NOT HAVE ANY HISTORY OF HERPES INFECTION ATTHE PROPOSED PROCEDURE SITE. I DO NOT HAVE EPILEPSY, DIABETES,ALLERGIC REACTION TO LATEX OR ANTIBIOTICS, HEMOPHILIA OR OTHER BLEEDING DISORDER. I DO NOT HAVE CARDIAC VALVE DISEASE OR SUFFER FROM ANY HEART CONDITIONS OR TAKE MEDICATIONS THATTHINS MY BLOOD. IF I SUFFER FROM HEPATITIS,OR OTHER RISK FACTORS FOR BLOODBORNE PATHOGEN EXPOSURE,OR ANY OTHER COMMUNICABLE DISEASE, I HAVE INFORMEDTHE TECHNICIAN OFTHE FACTAND HAVE BEEN ADVISED OF ANY MEDICATIONS AND PROCEDURE NECESSARYTO PROMOTE THE SATISFACTION HEALING OF MYTATTOO. I DO NOT SUFFER FROM ANY MEDICAL OR SKIN CONDITION(S)SUCH AS, BUT NOT LIMITED TO: KELOID OR HYPERTROPHIC SCARRING, PSORIASIS ATTHE SITE OFTHE TATTOO/PERMANENT MAKE-UP,OR ANY OPEN WOUNDS OR LESIONS AT THE SITE OF THE TATTOO. 2