CONSENT AND RELEASE AGREEMENT FOR PERMANENT COSMETICS

Please fill out and submit all the information below prior to your appointment. Thank you!

Please read through the risks and hazards acknowledgements below and click the I agree to Terms of Services at the end to indicate you understand it all completely. I understand that a certain amount of discomfort is associated with this procedure and that swelling, redness and bruising may occur. I understand that sun, tanning beds, pools, some skin care products and medications can affect my permanent makeup. I will tell all skin care professionals or medical personnel about my permanent makeup procedures, especially if I’m schedule for an MRI. I understand that implanted pigment color can slightly change or fade over time due to circumstances beyond your control and I will need to maintain the color with future applications and a touch up session within 8-12 weeks. I understand that the proposed procedure(s) involved risks inherent in the procedure and have possibilities of complications during and/or following the procedures such as: infections, misplaced pigment, poor color retention and hyperpigmentation. I understand there is no refund policy, and no warranty or guarantee has been made to me as a result of this procedure. I understand I will be required to pay a fee for annual or subsequent touch-ups. I understand that tattoo inks/dyes and pigments have not been approved by the Federal Food & Drug Administration (FDA) and that health consequences of these products are unknown. Although my technician will do their best to assure I am happy with the results, the final result cannot be guaranteed. I certify that I have read or have had read to me the contents of this form. I understand the risks and alternatives involved in this procedure(s) and I have had the opportunity to ask questions and all of my questions have been answered. I acknowledge that I have reviewed and approved the material given to me and I authorize Angelina Phong, as my permanent cosmetics technician, to perform on my body the following procedures.
Please read through the risks and hazards acknowledgements below and click the I agree to Terms of Services at the end to indicate you understand it all completely. I understand that a certain amount of discomfort is associated with this procedure and that swelling, redness and bruising may occur. I understand that sun, tanning beds, pools, some skin care products and medications can affect my permanent makeup. I will tell all skin care professionals or medical personnel about my permanent makeup procedures, especially if I’m schedule for an MRI. I understand that implanted pigment color can slightly change or fade over time due to circumstances beyond your control and I will need to maintain the color with future applications and a touch up session within 8-12 weeks. I understand that the proposed procedure(s) involved risks inherent in the procedure and have possibilities of complications during and/or following the procedures such as: infections, misplaced pigment, poor color retention and hyperpigmentation. I understand there is no refund policy, and no warranty or guarantee has been made to me as a result of this procedure. I understand I will be required to pay a fee for annual or subsequent touch-ups. I understand that tattoo inks/dyes and pigments have not been approved by the Federal Food & Drug Administration (FDA) and that health consequences of these products are unknown. Although my technician will do their best to assure I am happy with the results, the final result cannot be guaranteed. I certify that I have read or have had read to me the contents of this form. I understand the risks and alternatives involved in this procedure(s) and I have had the opportunity to ask questions and all of my questions have been answered. I acknowledge that I have reviewed and approved the material given to me and I authorize Angelina Phong, as my permanent cosmetics technician, to perform on my body the following procedures.
Please type your full name to indicate your agreement to this authorization for treatment.