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MICR®BLADING TREATMENT CONSENT FORM <br /> STATEMENT: <br /> Client's name: <br /> Date of birth: <br /> Address: <br /> City: State: Zip code: <br /> Phone: Email: <br /> Please read and add your initials on each line if you argee with the following statements: <br /> I 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 />