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Microblading & Tattooing by Mimi Chaves Diva’s Salon & Spa – 801 South Ham Lane, Lodi, CA 95242 Cell: (805) 260-2329, Email: mjcmicroblading@gmail.com Page 3 of 5 Signature Date Address I Acknowledge that: The information contained in this Informed Consent was explained to me using terms I could understand, and all my questions and concerns have been answered. After reviewing all the information provided to me about cosmetic procedures and reviewing my health status, I believe I am a good candidate for microblading and/or tattooing procedures. I understand that tattooing and microblading is an elective procedure and hereby freely accept all possible risks, complications, side effects that may result from this procedure. I understand that I am responsible to apply numbing cream approximately 1 hour prior to my scheduled appointment. Failing to do so may result in the loss of my appointment. If there is a history of Lupus, Herpes simplex or light sensitivity, I will let Marian Chaves know and to take the necessary means to protect myself by taking medication or avoiding therapy as directed. It is my responsibility to follow the appropriate aftercare instructions as explained and written in the post-care instruction that are given after treatment. No absolute guarantee of any kind has been made to me regarding the procedure, the number of procedures or its outcome. I have discussed the Procedure, Alternative treatments, Risks and had the opportunity to ask questions. I agree to the photographing of my procedure. We may use these photographs for advertising and illustrative purposes. I understand that I will not be identifiable in these photos (except for the nature of the tattoo itself) This consent form is valid for all future microblading and tattooing treatments performed, and I will alert Diva’s Salon and Spa if there are any future changes or my medical history, or if I become pregnant. Printed Name Phone Number Signature Date Address Aftercare Instructions READ THOROUGHLY! It is essential that you follow these instructions after your Microblading and/or Tattooing session. If you think you have an infection, seek medical attention immediately. Infections can include an odor coming from the brow area and a greenish or brownish discharge. If the infection becomes serious, the swelling may extend to the eyelids and the redness to the scalp or neck. If this happens, please consult your physician. Day 1 (Day of treatment): 2-3 hours after treatment, gently clean the area with a very small amount of sterile water on a cotton pad, just barely damp, NOT wet. Day 2 & 3: When you wake up, gently wipe the area with a small amount of sterile water on a