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LAW LO US Allure Beaute ' Treatment : Microblading/ 31) Eyebrow Embroidery Statement of Consent and Recitals : Please read and initial alllines Aftercare instructions have been explained to me and a written copy has been given to me to retain in my possession, which I will follow to the best of my ability. If I have questions, I will call or email you . I understand that a certain amount of discomfort is associated with this procedure, and that swelling, redness and bruising may occur . I understand that RetinA, Renova, Alpha Hydroxy and Glycolic Acids must not be used on treated areas . They will alter the color and cause premature exfoliation of the pigment. I understand that tanning beds, pools, some skin care products and medications can affect my permanent makeup . I understand that successful color saturation can NOT be guaranteed due to hidden scar tissue . I will tell all skin care professionals or medical personnel about my permanent makeup procedures, especially if I am scheduled for an MRI . I accept the responsibility to explain to you by desire for specific colors, shape, and position for any procedure done today. I understand that implanted pigment color can slightly change or fade over time due to circumstances beyond your control, and I will need to maintain the color with future applications and a touch-up session within 60 days . I acknowledge that the proposed procedures(s) involve risks inherent in the procedure, and have possibilities of complications during and/or following the procedures such as : infection, misplaced pigment, poor color retention and hyper-pigmentation . I have been advised that a touchup session is highly recommended to make any adjustments to shape, color, and to fill any pigment that may have had poor retention. Touch-ups must be completed within 60 days of initial procedure . I have been quoted the cost of today ' s appointment, and the cost of the touch-up . Touch-ups must be completed within 60 days of initial procedure or an additional cost may apply . All information gathered from the client that is personal medical information and that is subject to the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) or similar state laws shall be maintained or disposed of in compliance with those provisions . I have truthfully represented to the Technician that I am 18 years of age or older. I am not under the influence of any drugs or alcohol . To my knowledge, I do not have any physical, mental, or medical impairment or disability that might affect my well being as a direct or indirect result of my decision to have a tattoo at this time . STATEMENT OF CONSENT