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*-w <br /> 1 understand that I may need a second session of 3D Hair Strokes if my skin does not hold pigment with just one session. Everyone's <br /> skin is completely different and may require multiple sessions to lock in pigment. (initial) <br /> I understand that while this procedure is considered semi-permanent,there is a possibility that the ink will not fade and results may <br /> be permanent. (initial) <br /> I understand the taking of before and after photographs of procedures are required and that some photographs may be taken <br /> during the procedure. I also understand that exceptional photographs or results may be used in advertising or promotional materials <br /> and give permission for such usage. I also understand that any photographs will not be used for such purposes if I withhold <br /> permission. Permission granted Permission withheld (initial one) <br /> I have been given an opportunity to ask questions about the procedures,equipment,past experiences,and/or the methods to be <br /> used as well as the risks and hazards involved and I believe that I have sufficient information to give this informed consent. <br /> (initial) <br /> By signing this patient waiver and release agreement I,the patient named below,certify that I knowingly and voluntarily release <br /> Plastic Surgery Center of Stockton and its directors,officers,owners,employees,agents and representatives from any and all claims <br /> for damages for personal injury arising from the application and procedure of semi-permanent 3D Hair Strokes including damages <br /> relating to known or unknown complications which may arise during or following the application process including but not limited to <br /> claims from negligence. I further release and hold harmless Plastic Surgery Center of Stockton from any claims relating to preexisting <br /> conditions I have not revealed or changes to those conditions subsequent to the procedure. (initial) <br /> I, (client),certify that I have read and fully understand this patient waiver and release <br /> agreement.I hereby authorize Plastic Surgery Center of Stockton to provide semi-permanent 3D Hair Strokes on to my own natural <br /> eyebrows and skin,in accordance with the terms and conditions set forth in this customer waiver and release agreement. <br /> Patient Signature Date <br /> Witness Signature Date <br /> For office use only: <br /> Blade Gauge: Blade Invoice/Lot# <br /> Ink Color: Numbing: <br />