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First Name Please read and check each box: * I understand that a certain amount of discc may occur. I understand that sun, tanning beds, pools, i I understand that implanted pigment color and that I will need to maintain the color with fut I am 18 years of age or older Phone Number (_) is associated with this procedure and that swelling, redness and bruising skin care products and medications can affect my permanent makeup. r slightly change or fade over time due to circumstances beyond control applications and touch up session within 60 days. Permanent Nature of Microblading: semi-perman nt procedure where hair Tike incision strokes are created along the eyebrow to enhance, reshape, fill (cover gaps of to rl hair), extend the eyebrows, or fully reconstruct brows with little to no hair. (This ink is permanent but has to be touched ip every 1-2 years.) Permanent Nature of Ombre: a semi-permanent eyebrow technique that uses a small machine to place extremely thin dots of pigment into the skin, creating a soft -shaded brow pencil look. (This ink is permanent but has to be touched up every 1-2 years.) *Inks used for Possible Risks/ PAIN: There cc others. IN FECT must be kept c UNEVEN PIGM likely correct a asymmetrical, disappears wi Prilocaine, Be please inform level magnet permanentcc testto detern procedure I be pain even aftef the topical an V5: Infection is veryunusual. Less ion m and only touched with freshly c T: This can be a result of poor hea uneven appearances. ASYMMETR d adjustments may be needed dui ING: Some people bruise and swe the first few days. ANESTHESIA:I Caine, Tetracaine Epinephrine In a rr technician immediately. MRI: Pi be required if you need to be sca Mics. ALLERGIC REACTION: There FDA Approved and health consequences are unknown :thetic has been used. Anesthetics work better on some people than 0.25% of the population has an allergic reaction. The areas treated aned hands. See "After Care for Microblading/ombre" for Instructions. ng, infection, bleeding, or other causes. Your follow up appointment will Every effort will be made to avoid asymmetry, but our faces are ig the follow up session to correct any unevenness. EXCESSIVE more than others. Ice packs may help the bruising. and swelling. It typically apical anesthetics are used for numbing the area to be tattooed. Lidocaine, ream or gel form are typically used. If you are allergic to any of these ments used in permanent cosmetic procedures contain inert oxides; a low- ned by an MRI machine. You must inform your technician of any tattoos or a small possibility of an allergic reaction. You may take a 5 -7 -day patch F Yes, I hake read and understand the possible �isks, hazards, and complications.