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MICROBLADING TREATMENT CONSENT FORM <br />STATEMENT: <br />Client's name: <br />Date of birth: <br />Address: <br />City: <br />Phone: Email: <br />State: <br />Zip code: <br />Please read and add your initials on each line if you argee with the following statements: <br />I/ <br />1 certify that I am over the age of 18, 1 am not under the influence of drugs or alcohol, I <br />am not pregnant or nursing, and I consent to receiving the microblading procedure. The <br />general nature of microblading treatment to be performed has been explained to me. <br />I understand that a certain amount of discomfort is associated with this procedure <br />and that swelling, redness and bruising may occur. <br />I understand that Retin A, Renova, Alpha Hydroxy, and Glycolic Acids must not be <br />used on the treated areas. They will alter the color. <br />I understand that sun, tanning beds, pools, some skin care products and medications <br />can affect my final microblading result. <br />I will tell all skin care professionals or medical personnel about my permanent <br />makeup procedures, especially if I'm scheduled for an MRI (Magnetic Resonance Imaging). <br />I understand that implanted pigment color can slightly change or fade over time due <br />to circumstances beyond your control and I will need to maintain the color with future <br />applications and a touch up session within 6-8 weeks of initial procedure. <br />Aftercare instructions have been explained to me which I will follow to the best of my <br />ability. <br />There will be no refunds for this elective procedure(s). <br />