COMPLIANCE INFO - Laserfiche WebLink

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0 0 2. 1 acknowledge that complications as a result of semi-permanent makeup procedures may occur, particularly in the event that the post-procedure instructions are not followed, and accept full responsibility for such complications. 3. 1 realize that my body is unique and can not predict how my skin may react as a result of the procedure. 4. 1 am at least 18 years of age. 5. 1 understand that correction or touching up micropigmentation or cosmetic tattoo that was performed by others involves additional risks because of the existence of permanent pigments of unknown composition, brand, color, age, shape and other factors over which Chelsea Ramsey has no control. I understand that additional appointments after the initial appointment may be required, and will be billed with standard rates. I understand that Chelsea Ramsey cannot predict the results in advance and can not guarantee the results will be as I desire. I understand and fully accept the risks associated with this procedure and hold Chelsea Ramsey harmless from same. 6. 1 acknowledge that the procedure may result in long-lasting change to my appearance and that no representations have been made to me as to the ability to later change of remove the results. 7. 1 understand that the future skin altering procedures such as laser treatments, plastic surgery, implants, and/or injections may alter and degrade my semi-permanent makeup, and I must inform any future service provider that I have had micropigmentation applied. I understand and accept that such changes are not the fault of Chelsea Ramsey. I further understand that such changes or degradation in my appearance may not be correctable through further semi-permanent makeup procedures. 8. 1 acknowledge that obtaining the semi-permanent makeup is my choice alone. I consent to the procedure and to its attendant risk, and to any actions or conduct of Chelsea Ramsey reasonably necessary to perform the procedure. 9. 1 understand that I will have the opportunity to approve the design and color of the semi- permanent makeup to be applied, and accept responsibility for same. 10. (OPTIONAL) I consent to any relevant photographs being taken both before and after the procedure to document the results of the procedure. I consent to Chelsea Ramsey using"before&after" photos of me for marketing purposes to display its capabilities and results. If I do provide consent, I may at any time withdraw such consent for specific photographs by contacting Chelsea Ramsey. I have read and understand the contents of each statement above. I acknowledge that this is a contract, and that I have received no warranties or guarantees with respect to the benefits to be realized from, or consequences of,the aforementioned procedure. I further acknowledge that at the time of signing this consent I am of sound mind and capable of making independent decisions for myself. CLIENT SIGNATURE DATE Technician statement: I have personally reviewed the above information with my client. TECHNICIAN SIGNATURE DATE