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Permanent Makeup (PMU) Consent and Medical <br /> Questionnaire <br /> Form B—California Health & Safety Code (H&SC §§119302-119303) <br /> Client Information <br /> Full Name: <br /> Date of Birth: (Must be 18 years or older) <br /> Phone Number: <br /> Email: <br /> Address: <br /> Procedure Information <br /> Type of PMU Procedure: <br /> Technician Name: <br /> Date of Procedure: <br /> Needle Description: <br /> Lot#: <br /> Sterilization Date: <br /> COPY OF CLIENT'S DRIVER LICENSE <br /> Description of Procedure <br /> The permanent makeup (PMU) procedure involves inserting pigment into the skin using a sterile <br /> needle to enhance or restore facial features such as eyebrows, eyeliner, or lips. <br /> What to Expect: <br /> • Redness, swelling, or tenderness may occur. <br /> • The color will appear darker initially and will lighten during healing (approximately 4-6 <br /> weeks). <br /> • A touch-up session may be needed for best results. <br /> Permanent Nature of Procedure: <br /> I understand that this is a permanent cosmetic procedure. While pigment fading can occur over <br /> time, complete removal may not be possible. <br />