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There is a possibility of an allergic reaction to pigments. A patch test is advisable however it does not <br />ensure a client will not have an allergic reaction. I consent (initial) or waive <br />(initial) the patch test. If waived, I release the technician from liability if I develop an allergic reaction to <br />the pigment. <br />I understand that if I have any skin treatment(s) it may result in adverse changes to my permanent <br />cosmetics. I acknowledge some of these potential adverse changes may not be correctable. <br />Initial <br />I have received pre- and post-treatment instructions and I will strictly adhere to such instructions. I <br />understand that my failure to do so may jeopardize my chances for a successful procedure. If I am on any <br />medication for depression or any other mood altering prescription, I will advise my technician. If I have <br />ever had cold sores, I will consult with and strictly follow my doctor's instructions before contemplating <br />any permanent cosmetic procedure around my lips. Initial <br />I understand that the taking of before and after photographs of the said procedure(s) are a <br />condition of such procedure(s). I certify I have read and initialed the above paragraphs and have <br />had explained to my understanding this consent and procedure permit. I accept full responsibility <br />for the decision to have this cosmetic tattoo work done. <br />CLIENT: DATE: <br />TECHNICIAN: <br />To be filled out by technician. <br />DATE: <br />Needle Number Model Invoice/Lot # Tech Initials/Date <br />Notes: <br />