Name*
Date of Birth*
Age*
Address*
Day/Cell Phone:*
Home Phone*
Email
I, acknowledge by signing below, that I have been given the full opportunity to ask any and all questions which I might have about the obtaining of any cosmetic tattoo procedures from ESBeaute Studio.*
I also acknowledge that all of my questions have been answered to my full and total satisfaction. I specifically acknowledge that I have been advised of the fact and matters set below, and I agree as follows:
I acknowledge that complications are always possible as a result of cosmetic tattoo procedure,particulary in the event that post-procedural instructions are not followed (initial)*
I have receied a copy of the Aftercare Instructions. (initial below)*
I REQUEST a patch test (requires rescheduling (initial below)*
I declined a patch test. (initial below)*
All subsesequent procedures including any additional touch ups are an additional fee (initial below)*
I realize that my body is unique and the practitioner cannot predict how my skin may react as result of the procedure. (initial below)*
Redheads, blondes & fair skin (Fits 1-2 skin types may be red, swollen and pigment MAY not take. Additional procedures may be a require to obtain desired results. (initial below)*
Results WILL appear softer as the treated area heals. The area/s treated WILL NOT look DEFINED or as BOLD as right after the procedure. (initial below)*
ALL procedures require 2 appointments & color boosts every 1-3 to keep the color fresh (initial below.*
Frequent tanning and sun exposure WILL heal darker & fade the pigment quicker. It is recommended to NOT have a tan/burn (30 days before/after) on your dace at the time of your procedure; (initial below)*
I acknowledge & understand that pigment implanted on darker skin types (i.e. Indian, African American, Filipino etc., the pigment will appear softer and blend more with your own skins melanin and will not appear as bold or defined as on lighter skin types an the hair strokes will be less visible. (initial below)*
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Alopecia Clients- Due to the change in skin texture, pigments may heal more powdered.(initial below)*
I acknowledge that the procedure will result in oermanent change to my appearance and that no repsentations have been made to me as to later change or remove the result. (initial below)*
Thyroid Conditions & Medicines, MAY prevent the pigment from retaining, fade quickly or change in color. I accept these potential risk & wish to proceed. (initial below)*
I acknowledge that the obtaining of cosmetic tattoo procedure(s) is by my choice alone, and I consent to the application of the procedure and accept the risks. (initial below)*
When you leave our office, the brows are intact. How your body heals them is out of the control of the technician. This is 100% your bodies job. Even when following the aftercare fading/poor retention can still happen depending on your skin & lifestyle. This is NOT the fault of the technician. (initial below)*
I understand that if any other technician applies permanent makeup over an area that was originally done by.( Add person below) she will no longer future treatments.*
NO EXCEPTIONS (initial below)*
In the event of a CAT or MRI scan, please inform your physician of Iron Oxide Cosmetic Tattoo as some pulling or burning (rare) may occur during the procedure(initial below)*
I understand that if I do abide by the strict aftercare, I can ruin my results. The Aftercare is crucial for optimum pigment retention. (inital below)*
Absolutely NO Refunds after services have performed.(initial below)*
I understand that a a certain point as the skin ages, cosmetic tattoo will no longer be an opition.(initial below)*
YOUR ARTIST CAN RELEASE ME AT ANY TIME FROM FUTURE SERVICES IF SHE FEELS POLICES OR PROCEDURES ARE NOT FOLLOWED(initial below)*
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Client Signature:*
Date
Confidential Medical Profile Name*
Date*
Occupation*
Phone
List medication below"
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Client Consent to be Photographed Date
