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General Consent and Procedure Permit Clients Full Name Phone Refered By. E -Mai I hereby authorize to perform upon myself permanent cosmetic enhancement. If any u -Foreseen condition arises in the course of the procedure(s) I further request and authorize her to use her =L1 judgement and do whatever he/ she deems advisable and necessary in the circumstances. I understand that semi-permanent and permanent cosmetic enhancement is an advanced form of -attooing. I accept responsibility for determining the color, shape and position of the enhancement as agreed I ring the course of my consultation. I uncerstard that a sensitivity test for pigment does not guarantee that I will not have an allergic re- s=onse. I am aware of that allergic response to pigment is rare and accept all responsibility if allergic re- s=onse occurs. I am aware that a sensitivity reaction to anesthetics can occur and accept all responsibility if allergic re-3ponse occurs. I fully understand and accept that non-toxic pigments are used during the procedure and that the smetic enhancement achieved may fade over the course of 1-3 years. Even though the color has faded, the pigment will stay in the skin indefinitely and may leave a light residue of color. I understand that dyes, inks and pigments are not approved by the Food and Drug Administration (FDA) and the health effects are not known. I accept that the highest standards of hygiene are met, and that sterile disposable needles are used for each ind vidual client, procedure and visit. I understand and accept that each procedure is a process requiring multiple applications of p gment t; achieve desirable results, and that 100% success cannot be guaranteed. I understand that this is why I may need to return for a touchup procedure that is included in the initial price. I understand that the touchup procedure, if required, will be performed 4-8 weeks after the initial l:i-ocedure and that after the 8 week period I will be charged an additional fee for any procedures. I will t ook the appointment when it is convenient for both parties. I understand that semi-permanent cosmetic enhancement is an invasive procedure and the infusion Process can be uncomfortable. _I am aware that the result of the procedure is determined by the following: Medication Skin Characteristics - i.e. dry/oily/sun-damaged Natural skin undertones Alcohol intake and smoking General stress A compromised immune system Poor diet Post procedure care treatment