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Do you take antibiotic's prior to surg ry or dental procedures? <br />CONSENT I certify that I am over the age of 1 r, and not under the influence of drugs or alcohol, and I consent to <br />receiving the Lip Blush procedure. I have bee informed and it was explained to me the general nature of cosmetic <br />tattooing as well as the specific procedure to_ �e performed. I have been informed of the possible risks and <br />consequences of eyeliner and I understand tat there might be complications and consequences associated with this <br />procedure, such as: infection, scarring, or inco sistent color. I understand that this cosmetic procedure is not fully <br />permanent and might result to fading in time. I have likewise received and will strictly adhere to procedural <br />Instructions given to me. Any adverse effects due to my failure to adhere to the instructions shall solely be my <br />responsibility. 1 have been advised to do a patch test to identify any allergic reaction to any medicine or anesthetics. <br />Should I waive for the test, I release the technician from liability If 1 develop an allergic reaction to any of the <br />procedure. I acknowledge that some changes Inight not be corrected In case 1 undergo other laser hair removal, <br />plastic surgery or other procedures. I understlind that photographs taken for comparison of the before and after <br />procedure are part of the said procedure. I accept full responsibility for the decision to have this eyeliner procedure <br />done. The cost for touch-up's after this first procedure are not included. <br />