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Informed Consent to Procedure 1. I absokMy understand and accept that such.procedure is a process,requiring a p applicationto achieve desirable r %success t be guaranteed. 2. Depending on the procedure(s),which I select I accept responsibilityfor determining the colov;shape, and position of eyebrows or eyeliner. 3. I understand the actual of the poyient may be modified after the procedure,due to the tone and color of my skin. 4. 1 undemtand that positioning of my procedures can be affected if I to have cosmetic surgery,Botox, or Restalyne. 5. I understand that if 1 have an MRI after the procedure,#tat! must tell the radiologist that I have iron oxide pe - 6. IfIama lens wearer, Irealize I must k e . procedure. 7. I understand that this procedure will fade and this fading can after the onginal pigment dolor and that this determines that it is time for a ch-up. 8. t realize that this is an elective tattoo process and therefore not an exact science,but an art, and is not medically 9. I understand Me permanent nature of body act and that permanent makeup falls under that category. 10. i understand that tattoo inks, pigments, and dyes have not been approved by the federal Food and Drug Administrationand that the health consequencesof using these . 11. I understand the following possibilitiesmayr.minor and temporary bleeding, swelling. infection,allergic reaction,scarring,keloid formation,corneal abrasion,bruising, redness other discoloration,inconsistent color,and or spreadingffanning of pigment 12. I agree to accompany my technician to the emergency rmn in the event they were to be accidentally ' my needle and take a blood test for their safety and disclose all test results to my technician. 13. I am aware that if an infection occurs after I have received permanent cosmetics to see my primary physician and to call the studkx _ 14. If I had permanent cosmetics Performed PmvWuslY by a technician, I will Blanca Rodriquez ponsi for future allergic reactions or contraindications. 15. I understand that the taking of before and after photographs of the said procedures are for the purpose of documentation,which may or may not be used for educational or advertising purposes. 16. l am over the age of 18 and am not under the influence of any drugs or alcohol. I have read and understood These risks Wed above and they have been explained to me. I DID NOT JUST SIGN THIS DOCUMENT I certify t1rat the irykmvatim in the above questionnaire is accurate and that It has been explained to rne and my questions have been answered. I accept full responsibility for any complications that may arise or result during or following the cosmetic procedures to be formed at my request. Signature of Client Date Signature of Technician Date