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Microblade Aesthetics Brows by Crystal Disclosure and Consent for Permanent Cosmetics I, .am 18 years of age and as a client havr requested that you describe the procedure to be utilized so that I may make an informed decision whether or not to undergo the procedure. You have described the recommended procedure to be used as Permanent Makeup,the process of implanting micro insertions of pigment into the dermal layer of skin. Permanent Makeup is a form of tattooing and the markings are permanent. I understand that there are no tattoos or permanent makeup pigments that have been approve by the Federal Food and Drug Administration.The health consequences of using these products are unknown. Please Initial: I hereby authorize Crystal Aguirre DBA Microblade Aesthetics/Brows by Crystal to take photographs and/or video of the work performed both before and after treatment, and I further authorize the use of said photographs to be used for the purpose of advertising. I have informed Crystal Aguirre DBA Microblade Aesthetics/Brows by Crystal that I am in good health and not under any care of a physician. I am currently under the care of a physician and I am being treated for the following condition(s). Physician's Name: Phone Number: Address: City/State: Zip: Please Initial: I have been given a copy of after care and acknowledge that failure to follow instructions may result in loss of color,discoloration, infection, etc. I have been told that there may be known and unknown risks and hazards related to the performance of the procedure planned for me and I understand that no warranty or guarantees have been made to me as to the results. I acknowledge the manufacturer of the pigment to be applied requires spot testing and specifically disclaims any responsibility for any adverse reaction to applied pigments. I understand spot testing may identify individuals who develop an immediate allergic reaction to pigment; However,spot testing does not identify individuals who may have a delayed allergic reaction to pigment. I agree to (circle one): RECEIVE WAIVE A spot test prior to application and I agree to release Crystal Aguirre DBA Microblade Aesthetics/Brows by Crystal and pigment manufacturer(s) from any and all liability related to allergic reaction or any other reaction to applied pigments.