Informed Consent

The nature and method of the proposed Permanent Make-Up procedure has been explained to me as having the usual risks inherent in the procedure and the possibility of complications during and following its performance. I understand there may be a certain amount of discomfort or pain associated with the procedure and that other adverse side effects may include minor and temporary bleeding, bruising, redness or other discoloration and swelling; fever blisters may occur on the lips following lip procedures in individuals prone to this problem. Fading and/or loss of pigment may occur. Secondary infection in the area of the procedures may occur, however, if properly cared for, is rare. 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 permanent cosmetic procedures from Christine Taylor, and/or any associates. 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 it is not reasonable possible to determine whether I might have an allergic reaction to any of the pigments, dyes, topical preparations or processes used in the procedure, and I agree to accept the risk that such a reaction is possible I have informed the practitioner of any existing problems. • I acknowledge that complications are always possible as a result of the permanent makeup procedure, particularly in the event that post procedural instructions are not followed. • I realize that my body is unique and the practitioner of any of the practitioner’s associates cannot predict how my skin may react as a result of the procedure. • I acknowledge that the procedure will result in a permanent change to my appearance and that no representations have been made to me as to the ability to later change or remove the result. • Understand that future laser treatments or other skin altering procedures such as plastic surgery, implants, and /or injections may alter and degrade mu permanent make up. I further understand that such changes are not the fault of the practitioner and/or any of the practitioner’s associates. I further understand that such changes in my appearance may not be correctable though further Permanent Make up procedures. • For the purposes of education or assistance, I consent to the admittance of authorized observers to the procedure(s). • I acknowledge that the obtaining of Permanent Make up procedure(s) is by my choice alone, and I consent to the application of the procedure and to its attendant risks, and to any actions or conduct of the practitioner and/or any of the practitioner’s associates reasonable necessary to perform the procedure(s).
  • I have read and understand the contents of each paragraph above. I acknowledge this is a contract and that I have receive no warranties or guarantees with respect to the benefits to be realized from. Or consequences of, the aforementioned procedure(s). I further acknowledge that at the time of signing the consent to this procedure(s). I was of sound mind and capable of making independent decision for myself.
  • If under 18
  • I have personally reviewed the above information with my client or the client’s representative.