FM Permanent Cosmetics Ltd General Consent and Procedure Form
Clients First Name: _____________________Last Name: _________________________
Email:____________________________________ Phone: ____________________________
I understand that permanent cosmetic enhancement is an advanced form of tattooing.
I accept responsibility for determining the colour, shape and position of the enhancement as agreed during the course of my consultation.
I understand that a sensitivity test for pigment does not guarantee that I will not have an allergic response. I am aware of that allergic response to pigment is rare and accept all responsibility if allergic response occurs. I am aware that a sensitivity reaction to anaesthetics can occur and accept all responsibility if allergic response occurs. I have completed a patch test prior to my appointment and followed the instructions, pigment and anaesthetic remained on my skin for 24 hours, no reaction has occurred.
I fully understand and accept that the cosmetic enhancement achieved may fade over time. Even though the colour has faded, the pigment will remain in the skin indefinitely and may leave a light residue of colour. All colour fades- this is a fact that also applies to pigments used for cosmetic tattooing. How much colour you retain largely depends on your skin characteristics and type of method used. After your procedure(s) has been performed and any subsequent work performed at the post-procedure appointment, the pristine appearance of your permanent cosmetics is very dependant on daily maintenance of avoiding direct sunlight, avoiding strong chemicals applied to the procedural area, and apply a sun block product daily factor 30+ more frequently if you work outdoors. Future Colour-boosts are recommended to maintain the enhancement. The time frame for that need cannot be predicted, as this aspect of permanent cosmetics is very client specific.
I am aware that the result of the procedure is determined by the following: Medication Skin Characteristics – i.e. dry/oily/sun-damaged Natural skin undertones Alcohol intake and smoking General stress A compromised immune system Poor diet Post procedure care treatment
I accept that the highest standards of hygiene are met, and that sealed sterile disposable needles are used for each individual clients procedure at each visit.
I acknowledge that hyperpigmentation (darkening of the skin) or hypopigmentation (the absence of colour in the skin), or scarring is a possibility as results of my body’s reaction to the skin being broken during the procedure. I realise that my body is unique and that my permanent makeup technician or her associate (s)cannot predict how my skin may react as a result of this procedure. I understand that the pigment may migrate under the skin, my permanent makeup technician has explained complications such as migration (particularly with reference to eyeliner procedures) however this is a rare occurrence.
I understand and accept that each procedure is a process and can require multiple applications of pigment to achieve desirable results, I am aware that cosmetic tattooing is not an exact science, and I acknowledge no guarantees have been made to me as to the results of the procedure. I acknowledge I need to return for a fine tune procedure that is included in the initial price, and the fine tune procedure will be performed 1-3 months after the initial procedure. After this 3-month period I will be charged an additional fee. I also understand that a fine tune procedure cannot be done less than 4 weeks after the initial application to allow the skin to fully heal. I will book the appointment when it is convenient for both parties
I understand that future laser treatments or other skin altering procedures, such as plastic surgery, implants, and injections may alter and degrade my permanent makeup. I further understand that such changes are not the responsibility of my permanent makeup technician. I further understand that such changes in my appearance may not be correctable through further permanent makeup procedures
I understand that loss of any eyelashes during the healing of permanent cosmetic eye enhancements will result in new eyelash growth over a 4 month period and that eyelash loss is rare and minimal.
I understand that in rare cases a corneal abrasion could occur during eyeliner procedures as anaesthetic are used to keep me comfortable. Saline eye wash will be used to regularly flush the eyes to reduce any risk.
I have been advised that upon completion of the procedure there may be swelling and redness of the skin, which will subside within 1-4 days dependent on lifestyle. In some cases bruising can occur. I have been advised that I can resume normal activities immediately following the procedure, however, using cosmetics, prolonged exposure to water, excessive perspiration and exposure to the sun should be limited for up to two weeks following the infusion process. I understand that immediately after the procedure the enhancement can be 30 to 50% darker than the desired result and can take between 4-10 days to lighten. I understand that the true colour will be visible 1 month after each application, and that the colour may vary according to skin tones, skin type, and age and skin conditions. I appreciate that some skins accept colour more readily than others and no guarantee of an exact effect or colour can be given
I am aware that if I have had a previous outbreak of cold sores/herpes and receive a lip enhancement I may have an outbreak again following the procedure. I have been made aware that anti herpes medication is available over the counter or on prescription and has been shown to prevent or minimize such outbreaks. I am aware that if I have had a previous eye disorder or eye infection and receive an eyeliner enhancement, the disorder may reoccur again. I agree to use the correct medication to prevent such a disorder reoccurring. I am aware that even though my vision is not affected by permanent cosmetic eye enhancements I may wish to have someone drive me home. I understand that I may experience dry lips for up to two weeks following permanent cosmetic lip enhancement. I understand that scar camouflage procedures require skin colour-matching tests before the procedure commences and require multiple individual sessions to build colour and will not give the result of an undetectable scar.
I understand that tattoos may cause MRI (Magnetic Resonance Imaging) artefacts and that there may be a warming and/or tingling sensation in the permanent cosmetic procedural area during the MRI due to the iron oxide (metallic salts) properties of some of the pigment enters. It is understood that is should advise my doctor that I do have permanent cosmetics (a tattoo) in the event an MRI procedure is prescribed.
The nature of the proposed permanent cosmetic procedure has been explained to me by my technician and or by her associate (s) including the usual risks inherent in the tattooing process, and the possibility of complications during or following its performance. Secondary infection in the area of the procedure may occur; however, if properly cared for, is rare.
I hereby authorise Faye Marie/Laura to perform upon myself permanent cosmetic enhancement. If any unforeseen condition arises in the course of the procedure(s) I further request and authorise her to use her full judgement and do whatever she deems advisable and necessary in the circumstances.
I agree to follow all pre-procedure and post-procedure instructions as provided and explained to me by the technician. I understand that infection and possible scarring can occur if I do not adhere to the said instructions.
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 the procedure done at this time. I am at least 18 years old. I am not under the influence of drugs or alcohol. For the purpose of documentation, I also consent to the taking of “before” and “after” photographs of said procedure(s)
YOUR SIGNATURE BELOW REPRESENTS CONSENT FOR PERMANENT COSMETIC SERVICES AND REMAIN IN EFFECT DURING THE ENTIRE PERIOD YOU ARE A CLIENT OF FMPERMANENTCOSMETICS LTD. I CERTIFY THAT I HAVE READ, AND HAVE HAD EXPLAINED TO ME, AND FULLY UNDERSTAND THE ABOVE CONSENT FORM. I HAVE BEEN GIVEN, FULL OPPORTUNITY TO ASK ANY AND ALL QUESTIONS ABOUT THE PERMANENT COSMETIC PROCEDURE(S)AND PROCESS(S). I HAVE REQUESTED TO HAVE PERMANENT COSMETIC ENHANCEMENT OF MY OWN FREE WILL
Please tick this box if you DO NOT wish for your images to be used for advertising purposes (full face images will not be used unless further agreed by the client)
New Data Protection Law (GDPR) FM permanent Cosmetics Ltd & associated personal will NOT be able to contact you or hold your personal information or send appointment reminders and promotional offers without permission. Please could you sign below that you would still like us to be able to contact you and by which method. We would prefer to Email you, your reminder and notifications but we can text or call you if you prefer. I certify that I have read and fully understand the above information.
Clients Signature: ………………………………………………………………… Date:……………………