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I understand I will have permanent make-up applied using appropriate instruments and sterilization techniques. I understand that the permanent make-up site usually takes 2 weeks or longer to heal. I understand this is a tattoo process and therefore not an exact science, but an art. I request the microblading procedure and accept the permanence of the procedure as well as the possible complications and consequences of the said procedure. I understand that while this is sometimes referred to as semi-permanent in nature, due to each individual's reaction to pigment, the length of time pigment is present cannot be guaranteed. In some cases, pigment will be permanent. I agree to release and forever discharge, and hold harmless, the Technician, all employees, contractors, and the management of the permanent make-up studio from any and all claims of negligence, dams es, or legal actions arising from or connected in an way with m 9 9 9 Y Y Y tattoo, the procedure, and conduct used in my tattoo and assume all responsibility for the decision(s) made consenting to this permanentP rocedure. I am aware that permanent cos etic inks, dyes, and pigments have not been approved b the federal Food and Drug Administration and that the health consequences of PP Y 9 q using these products are unknown. I acknowledge infection is always possible as a result of permanent make-up application. I have received pre- and post-procedure instructions and I understand them and will strictly adhere to such instructions. I understand that my failure to do so may jeopardize my chances for a successful procedure. I agree that it is my responsibility to contact my Technician if there are any signs and symptoms of infection, including, but not limited to redness, swelling, tenderness of the procedure site, red streaks going from the procedure site towards the heart, elevated body temperature, or purulent drainage from the procedure site. I understand that the taking of before and after photographs of the said procedure are a condition of such procedure. I release all rights to any photographs taken of me and the permanent makeup and give consent in advance to this permanent make-up studio to use images of my tattoo(s) for marketing and, or publishing purposes in various media such as the internet, magazine, printed, and or television etc. I understand that if I have any skin treatments, laser hair removal, plastic surgery or other skin altering procedures, it may result in adverse changes to my permanent cosmetics. I acknowledge some of these potential adverse changes may not be correctable. I am not pregnant or nursing. I do not tie any hist ry of herpes infection at the prop ed procedu/re site. I do not have epilepsy, diabetes, allergic reyction to latex or antibiotics, hemophilia or other bleeding disorders. I do not have cardiac valve disease or suffer from any heart conditions or take medications that thins my blood. PAGE 2 OF 3