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i <br /> .a <br /> Permanent Makeup Consent Form <br /> Client Name: <br /> The nature and method of the proposed permanent makeup (cosmetic tattoo) procedure <br /> has been explained to me by my technician, including the usual risks inherent in the <br /> procedure process, and the possibility of complications during or following its performance. <br /> NOTE: Inks are not FDA approved and health consequences are unknown. <br /> I understand there may be a certain amount of discomfort or pain associated with <br /> the procedure and that the adverse side effects may include minor and temporary bleeding, <br /> bruising, redness or other discoloration and swelling. Fading or loss of pigment may occur. <br /> Secondary infection in the area of the procedure may occur, however if properly cared for, <br /> this is rare. <br /> I understand that a skin test of the pigment is offered upon request and the test <br /> result is not viewed by a medical professional unless I make arrangements to have this <br /> done myself. A non-reactive skin test does not mean that an allergic reaction occurring at a <br /> future point in time could occur. <br /> I decline the skin test OR I request a skin test. (Please initial one choice.) <br /> Client Signature: Date: <br /> I have informed my technician of any existing health problems. <br /> I acknowledge that complications are always possible as a result of the permanent <br /> makeup procedure, particularly in the event my post procedural instructions are not <br /> followed. <br /> I acknowledge that hyper-pigmentation (Darkening of the skin) or hypo- <br /> pigmentation, (The absence of color in the skin), or scarring is a possibility as result of my <br />