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Microblading by Mimi Chaves, Brow Divas- 4North School Street, Lodi Cell: (805)260-2329, Email: mjanicroblading@gmaibcom Page 2 of 4 MICROBLADING & COSMETIC TATTOOING IMF W, LIABILITY WAIVER Customer's. A brief description on what has been explained to you Initials It has been explained to me that the procedure to be used on me is referred to as Micro - pigmentation (the process of implanting micro -deposits of pigments into the epidermal layer of the skin). Micro -pigmentation is a form of tattooing used for the purpose of semi- permanent cosmetic makeup, and for skin imperfection camouflage tattoo coverup. I realize the procedure will most likely result in semi-permanent and possible irreversible color change in the skin area treated. However rare, some possible complications resulting from this procedure may include infection, scarring, swelling, bruising, numbness, post procedure discomfort, allergic reaction to pigments and/or anesthetic agents (topical) I understand the practice of this procedure is NOT an exact science. Colors may not match perfectly or appear exactly as expected. Over the weeks, months and year following the procedure, softening, fading or change of color of the pigment may occur. I understand that there is a possibility of hyper -pigmentation resulting from this procedure. I have been told that this procedure might involve some pain and discomfort. I understand that no warranty or guarantees have been made to me as to the result of this procedure. I understand that there will be "before and after" pictures will be taken of your eyebrows and used for marketing purpose. Your face will not be part of the images. I have been given the opportunity to ask questions about the procedure and the risks involved. I am aware that infections can include an odor coming from the brow area and a greenish or brownish discharge. If the infection becomes serious, the swelling may extend to the eyelids and the redness to the scalp or neck. If this happens, I understand I am to seek medical attention. The full amount is due at the beginning of the service. Payment is due in cash or PayPal. NO REFUNDS NO EXCEPTIONS. I understand that the description of the procedure is not meant to scare or alarm me, It describes the procedure so I may make an informed decision to proceed or refuse the procedure. In consideration of having the service provided by Marian (Mimi) Chaves, I fully release and discharge, without limitation, from any and all claims, losses, demands, rights of cause of action; damages or injuries to my person or property, present or future, whether known, anticipated or unanticipated, that may occur from any cause whatsoever, whether based on tort, contract, products liability, or other theory of recovery. As a result of or airing out any treatment or surgery that may arise from any treatment or procedure by Marian (Mimi) Chaves including, but not limited to, any claims for consequences, and known and unknown developments of any such injuries, and claims with respect to the nature, extent,and permanency of any such injuries. I understand and agree to the above. Printed Name Signature Date r��ra.mm:r--r