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Disclosure and Consent for Tattoo and Dermal Procedures <br />(page 2 of 2) <br />I have been told that this procedure will involve pain and discomfort. <br />I have been told that the markings are permanent and there is a risk of pigment migration and infection <br />following the procedure. <br />I have been told that a follow-up procedure may be required and that the color or the pigmentation may <br />fade. <br />I have been told that there is a chance of allergic reaction to pigment and that my body may reject the <br />pigment. <br />I have been given the opportunity to ask questions about the procedure and the procedure to be used, the <br />risks and the hazards involved, and I believe that I have sufficient information to give this informed consent. <br />I understand that if I have an infection, adverse reaction or allergic reaction to the procedure, I must notify <br />Jenna immediately. <br />I have received a copy of the Post Procedure Instructions. It has been fully explained to me and I have <br />read it or it has been read to me. I understand its content. <br />I certify that this form has been explained to me and I have read it. I understand its content. <br />I am at least 18 years of age. <br />Print Name <br />Signatu <br />Date <br />