Laserfiche WebLink
Phone Number <br />Area Code Phone Number <br />CQNSENT I certify that I am over the age of 18, and not under the influence of drugs or alcohol, <br />and I consent to receiving the microblading/Ombre procedure. I have been informed and it was <br />explained to me the general nature of cosmetic tattooing as well as the specific procedure to be <br />performed. I have been informed of the possible risks and consequences of microblading/ombre <br />and I understand that there might be complications and consequences associated with this <br />procedure, such as: infection, scarring, or inconsistent color. I understand that this cosmetic <br />procedure is not fully permanent and might result to fading in time. I have likewise received and <br />will strictly adhere to procedural instructions given to me. Any adverse effects due to my failure <br />to adhere to the Instructions shall solely be my responsibility. I have been advised to do a patch <br />test to identify any allergic reaction to any medicine or anesthetics. Should I waive for the test, I <br />release the technician from liability if I develop an allergic reaction to any of the procedure. I <br />acknowledge that some changes might not be corrected in case I undergo other laser hair <br />removal, plastic surgery or other procedures. I understand that photographs taken for <br />comparison of the before and after procedure are part of the said procedure. I accept full <br />responsibility for the decision to have this microblading/ombre procedure done. The <br />cost for touch-up's after this first procedure are not included. <br />Signature <br />Submit <br />®F Now create your own Jotform - It's free] Create your own Jotform <br />