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History of- allergic. reactions to latex? History of allergic reactions to antibiotic ?. - History of hemophilia or other bleeding isorders? History of cardiae valve disease? - Anyiather blood borne pathogen usk fine rs? - - Please list down any medications yo I i Do you take antibiotics prior to surge i i CONSENT I certify that I am over the age of 1 receiving the Lip Blush procedure. I have beet tattooing as well as the specific procedure to t consequences of Microblading/Ombre and I ui associated with this procedure, such as: infect procedure is not fully permanent and might re' procedural instructions given to me. Any adve my responsibility. I have been advised to do a anesthetics. Should I waive for the test, I releE the procedure. I acknowledge that some than plastic surgery, or other procedures. I unders procedure are part of the said procedure. I act procedure dotpe. The cost for touch-ups after 1 Signature: are taking: or dental procedures? and not under the influence of drugs or alcohol, and I consent to formed and it was explained to me the general nature of cosmetic performed. I have been informed of the possible risks and etsland that there might be complications and consequences n, scarring, or inconsistent color. I understand that this cosmetic It to fading in time. I have likewise received and will strictly adhere to effects due to my failure to adhere to the instructions shall solely be atch test to identify any allergic reaction to any medicine or the technician from liability if I develop an allergic reaction to any of s might not be corrected in case I undergo other laser hair removal, td that photographs taken for comparison of the before and after pt full responsibility for the decision to have this Microblading/Ombre s first procedure are not included.