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20 <br /> CONSENT <br /> I, currently have an unwanted tattoo/ permanent makeup. This <br /> tattoo/ permanent makeup is located on the (area of body). This area was last <br /> tattooed on (approximatedate)by (name of <br /> e business or technician). <br /> This tattoo or permanent makeup is unwanted because <br /> indicate s ape,color,location). <br /> I would like the technician to attempt to; (a) remove the entire tattoo if possible; or ) <br /> partially remove the to (check one). <br /> I understand that several treatments may be n der to attempt to achieve my desired results. I <br /> have not been given any guarantees as to the quality of the removal results. <br /> I understand there are several medical and esthetic options available for the removal of my tattoo or <br /> permanent makeup. I have decided to choose the Rejuvi removal technique at this time. <br /> I understand that the unwanted tattoo/ et makeup may not be successfully removed d that <br /> permanent scarring may result in an attempt to remove the tattoo/permanent makeup as well as <br /> hypertrophy d hypo-pignientation or other damage to the skm whichmay be permanent. <br /> I understand that removing tattoos/permanent makeup is difficult and complicatedprocess. As a result <br /> I will not hold the technician of this establishment responsible for any resultant it to remove <br /> partially or totally. <br /> Furthermore, I will not hold the salon or the business of the technician,the distributor and the <br /> manufacturer of the tattoo removal products used in this attempted tattoo removal, liable for any <br /> damages that may occur to my face or body. <br /> I agree to be taken the photographs "before" and"after'the treatments and to conform Wall rules and <br /> regulations established by the technician n listed belo,%-. for the removal of unwanted tattoo or <br /> /permanent makeup. I agree to follow all aftereare instructions. <br /> I have been duly informed of the nature,risks,possible complications and consequenceslisted <br /> above. I further understand that the above listed technician is nota medical doctor and have neither <br /> askednor received y guarantees or promises as to the results obtained. <br /> I understand everything escri above,have had my questions answered,agree that it is all true and <br /> correct and by my signature below I agree to the above. <br /> Signature of client ate: <br /> Address: <br /> Business name Technician name <br /> Address: <br /> Signature of technician Date: <br />