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t Y GENERAL CONSENT IVERLASTl PROCEDUREFORM Please read this form fully and sign at the end.If you are unsure about a particular detail of the form,please speak to your therapist If unforeseen condition arises in the course of microblading/PMU procedure,I authorise my therapist to use their professional judgement to decide on what he/she feels necessary in the given circumstances. I accept the responsibility for determining the colour, shape and position of the microblading/PMU procedure as agreed during consultation. I understand that an allergy test,does not guarantee that l wilt not develop an allergic reaction to the pigment I fully understand and accept that non-toxic pigments are used during the procedure and that-the result achieved may fade over a period of 1-3 years.Even once the colorer will face,pigment itself may stay in the skin indefinitely. I have been informed that highest standards of hygiene are met and that sterile,di needles and pigment containers are used for each individual client,procedure and visit. I understand and accept that each procedure is a process rewiring multiple applications of pigrrxenc to achieve desired results,and that'd success cannot be guaranteed°durintFrerst l d' l than Have to return for a repeated procedure. The result of the procedure is determined by the following;medication,skin characteristics(dry,oily,sun-damaged, thick or thin skier typel Personal pH balance of your skin,alcohol intake and smoking,post procedure after care. Upon completion of the procedure there might be swelling and redness of the skin,which will subside between 1-4 days.In some cases bruising may;occur.You may,resume your normal activities following the procedure,however; using cosmetics,excessive perspirapoh antl exlmsure of.the sun shouldbe limited untildie skin hasfully heated..Please see after care card for more details:You can be assure that .procedure resin will look acceptable for you to appear in public without additional make-up on thea I have been advised that the true colour will be seen t month after each procedure;and that the pigment may vary according to skin tones,skin type,age and skin condition.I understand that some s W;types accept pigmeat more readily and no guarantee on exact coksur cap be given. To my knowledge I do not have arr"physical,rrrentak or medlcat impel gird' itythat might affect my well being as a director indirect result of my decision to have the.procedure done at this time. I agree to follow all pre-procedure and post-procedurekwuctionsas provided and expla'; ,tome bythe technician. I can confirm that 1 have received a copy of aftercaredetails. Being of sound mind and body,I herby release any and all res 'bility.I accept any : all responsibility myself for any consequences that might stem from nay decisions tis have any permanent cosrnedcsprocedure performed by (technician) {Therapists full name) For the purpose of documentation,record and mpW po Y ,also consent to the taking o€'be€ore"and "after"photographs of my procedure. I CERTIFY THAT 1 HAVE READ AND FULLY UNDERSTAND THE ABOVE CONSENT ANDJPRbCEDURE PERMIT, THAT THE EXPLANAMONS THEREIN REFERRED TO WERE MADE -AND I ACCEPT FULL RESPONSIBILITY FOR THESE AND OR OTHER COMPLICATIONS WHICH MAY ARISE OR RESULT DURING OR FOLLOWING THE MICRO DING/PMU PROCEDURE. THE TREATMENT IS PERFORMED AT MY RE-QUEST ACCORDING TO ,THIS CONSENT, PRE-POROCEDURk FO AND P PROCEDURE GUIDELINES.i HERBY OTHOISE TECHNICiAN IFull name) TO PERFORM MICROBLADING PROCEDURE ON ME AT (Address of the salon) Client Name: Surname: Date: Address: DOB: Signature: Technician`s Name: Surname: Date: Salon address ®&eaaaing8rov4 C#mtConsukation Poon 20377