Clients First Name: _____________________ Last Name: _________________________
Email: ____________________________________ Phone: ___________________________
Address: ____________________________________________________________________
I understand that permanent cosmetic enhancements are 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 that an allergic response to pigment is rare and I accept all responsibility if an allergic response occurs. I am aware that a sensitivity reaction to anaesthetics can occur and I accept all responsibility if an 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 and no reaction has occurred.
I fully understand and accept that the cosmetic enhancement 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. How much colour I retain largely depends on my skin characteristics and the type of method used. After my procedure(s) and any subsequent work has been performed, I understand that the appearance of my permanent cosmetics is very dependant on my daily maintenance of avoiding direct sunlight, not using strong chemicals around the procedural area, and applying an SPF30 (at least) suncream everyday. It has been recommended to me that I should book colourboosts in the future to maintain my enhancement and I understand that 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 (dry/oily, sun-damaged, natural skin undertones, etc), alcohol intake, smoking, general stress, compromised immune systems, and whether I follow the aftercare instructions given to me.
I agree that in the clinic, the highest standards of hygiene are met and new sealed sterile disposable needles are used for each new client or each new procedure (if having more than one).
I acknowledge that hyperpigmentation (darkening of the skin) or hypopigmentation (the absence of colour in the skin), or scarring is a possibility as a result 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 could migrate under the skin and my permanent makeup technician has fully explained all potential complications, but that they are 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 no guarantees have been made to me in regards to the results of the procedure. I acknowledge that I need to return for a finetune session within 3 months of my first treatment session, which is included in the initial price. After this 3 month period, I understand that I will be charged an additional fee for a top up. I also understand that a finetune 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 or degrade my permanent makeup. I further understand that such changes are not the responsibility of my permanent makeup technician and they may not be correctable through further permanent makeup treatments.
I understand that I could lose some eyelashes during the healing of my permanent cosmetic eye enhancements but that they should grow back over a 4 month period.
I understand that in rare cases, a corneal abrasion could occur during eyeliner procedures as anaesthetics 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, redness or bruising of the skin, which will subside within 1 to 4 days, dependent on my lifestyle. I have been advised that I can resume normal activities immediately following the procedure, but using cosmetics, prolonged exposure to water, excessive perspiration and exposure to the sun should be limited for up to 2 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 to 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, age and skin conditions. I appreciate that some skins accept colour more readily than others and there is no guarantee of an exact effect or colour.
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, which has been shown to prevent or minimise 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, it may be safer to have someone drive me home. I understand that I may experience dry lips for up to 2 weeks following a permanent cosmetic lip enhancement. I also know that scar camouflage procedures require skin colour-matching tests before the procedure commences, multiple sessions will be needed to build up colour, and that it is not guaranteed to 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 procedural area during the scan because of the iron oxide (metallic salts) properties in some of the pigments. It is understood that I should inform my doctor of permanent cosmetic tattoo if I have to undergo an MRI procedure.
The nature of the proposed permanent cosmetic procedure has been explained to me by my technician or by her associate(s), including the usual risks involved in the tattooing process, and the possibility of complications during or following the procedure. I understand that secondary infections in the procedural area may occur but if they are properly cared for, they are rare.
I hereby authorise Faye Marie/Laura to perform a permanent cosmetic enhancement on myself. If any unforeseen condition arises in the course of the procedure(s) I further request and authorise them to use their full judgement and do whatever they deem advisable and necessary given the circumstances.
I agree to follow all pre-procedure and aftercare 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 the best of my knowledge, I do not have any physical, mental, or medical impairments or disabilities 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 and 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 the said procedure(s).
My signature below represents consent for permanent cosmetic services, which will remain in effect during the entire period I am a client of FM Permanent Cosmetics Ltd. I certify that I have read, had explained to me, and understand all of the consent form above. I have been given full opportunity to ask questions about the permanent cosmetic procedure(s) and process(s). I have requested to have the permanent cosmetic enhancement on my own free will.
Clients Signature: __________________________ Date: ___ / ___ / ______
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)
Under the new Data Protection Law (GDPR), FM Permanent Cosmetics Ltd and associated people will not be able to contact you, hold your personal information or send appointment reminders and promotional offers without permission. Please specify below if you would like us to be able to contact you and by which method. We would prefer to email you but we can text or call you if you would prefer that. I certify that I have read and fully understood the above information.
Clients Signature: __________________________ Date: ___ / ___ / ______
Would you like us to contact you?: Yes / No Chosen Contact Method: _________________