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First Name Please read and check each box: I understand that a certain amount of may occur. I I understand that sun, tanning beds, pools, Phone Number () is associated with this procedure and that swelling, redness and bruising skin care products and medications can affect my permanent makeup. I understand that implanted pigment coloray slightly change orfade overtime due to circumstances beyond control and that I will need to maintain the color with futu a applications and a touch up session within 60 days. 1 am 18 years of age or older Permanent Nature of eyeliner involves using a t of eyeliner. (This ink is permanent but has to be 'Inks used for Eyeliner procedure are not Possible Risks/hazards/Comolications PAIN: There coi�id be pain even after the topical ar others. INFECTIONS: Infection is very unusual. Less must be kept clean and only touched with freshly c PIGMENT: Thislcan be a result of poor healing, infe correct any uneven appearances. ASYMMETRY: Eve and adjustments may be needed during the follow Some people bruise and swell more than others. Ic first few days, ANESTHESIA: Topical anesthetics are Benzocaine, Tetracalne Epinephrine in a cream or{ yourtechnician immediately. MRI: Pigments used i may be required if you need to be scanned by an N cosmetics. ALLERGIC REACTION: There is a small pt determine this! IIT Have you had or currently have any o Currently Pregnant Cmtently Breastfeeding Had'history of Methicdhn-resistant Stapl technique to apply ink along the lash line to create the appearance up every 3-5 years.) and health consequences are unknown ;thetic has been used. Anesthetics work better on some people than ion 0.25% on the population has an allergic reaction. The areas treated aned hands. See "After Care for eyeliner" for instructions. UNEVEN ion, bleeding, or other causes. Your follow up appointment will likely V effort will be made to avoid asymmetry, but our faces are asymmetrical, D session to correct any unevenness. EXCESSIVE SWELLING/BRUISING: packs may help the bruising and swelling. It typically disappears within the is for numbing the area to be tattooed. Lidocaine, Prilocame, I form are typically used. If you are allergic to any of these please inform permanent cosmetic procedures contain inert oxides; a low-level magnet I machine. You must inform your technician of any tattoos or permanent ;ibility of an allergic reaction. You may take a 5 -7 -day patch test to kiist�ry t.�uesticanreaire the following? aureus (MRSA) �` -