Makeup and Lipblush Consent Form | Blinks And Brows Boutique

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Permanent Makeup and Lip Blush
Consent Form

First Name

Email

Last Name

Address

Phone Number

Appointment's Date

I acknowledge that obtaining permanent make-up is my choice alone. The application of permanent make-up will result in a permanent change to my appearance, and that needles and inks will go into my skin. No representations have been made to me as to the original condition, and it is very costly to remove.

I am not pregnant or nursing. I do not have any history of herpes infection at the proposed procedure site. I do not have epilepsy, diabetes, allergic reaction to latex or antibiotics, haemophilia or other bleeding disorders. I do not have cardiac valve disease or suffer from any heart conditions or medications that thins my blood.

If I suffer from hepatitis, or other risk factors for blood borne pathogen exposure, or any other communicable disease, I have informed the Technician of the fact and have been advised of any medications and procedure necessary to promote the satisfactory healing of my tattoo.

I do not suffer from any medical or skin condition(s) such as, but not limited to : Keloid or hypertrophic scarring, psoriasis at the site of the permanent make-up, or any open wounds or lesions at the site of the tattoo.

I do not have a history of medications use or currently using medication, including being prescribed antibiotics prior to dental or surgical procedures.

I have advised the Technician of any allergies to latex gloves, or medications. I acknowledge that such a reaction is possible.

I have truthfully represented to the technician that I am 18 years of age or older. I am not under the influence of any drugs or alcohol. To my knowledge, I do not have any physical, mental, or medical impairment or disability that might affect my well-being as a direct or indirect result of my decision to have a tattoo at this time.

I acknowledge infection is always possible as a result of permanent makeup application, and I agree to follow all suggested instructions concerning the care of the permanent make-up site while it is healing.

I acknowledge and give consent to this permanent studio to use images (before and after) of my tattoos(s) for marketing and, or publishing purposes in various media such as the internet, magazine, printed, and or television etc.

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 agree to release and forever discharge, and hold harmless, the technician, all employees, contractors and the management of the permanent makeup studio from any and all claims of negligence, damages, or legal actions arising from or connected in any way with my tattoo, the procedure, and conduct used in my tattoo and assume all responsibility for the decision(s) made consenting to this permanent procedure.

I am aware that permanent cosmetic inks, dyes, and pigments have not been approved by the federal Food and Drug Administration and that the health consequences of using these products are unknown.

By Signing below, I verify that I have read and understand the above statements and agree to them.

Your Signature

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5 First St unit 3, Orangeville, ON L9W 1E1, Canada

Permanent Makeup and Lip Blush Consent Form

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Permanent Makeup and Lip Blush
Consent Form