Disclosure and Informed Consent Form:
If you are human, leave this field blank.
I, ....................................................................................understand the nature of permanent makeup and microblading. It has been fully explained to me, as well as the usual risk inherent in the procedure and the possibility of complications during and after it’s procedure. I understand the process of Micro Pigment Implantation as the process of implanting micro insertion of pigment into the upper dermis of the skin. It is a form of tattooing used for the purpose of permanent cosmetic makeup. I understand that there might be slight swelling, redness and discomfort. Fever blisters may occur following lip procedures on clients prone to the problem. Necessary care needs to be done before and after the procedure. I am also prepared for the colour intensity to be significantly darker, sharper or brighter that what is expected for the final outcome. It will take approximately 7-14 days for this transition. Fading of the pigment may be as much as 80% after the first application. One to 2 touch-ups may be required at 6 weeks interval to complete the procedure and reach the desired effect. I understand that no warranty or guarantees have been made to me as to the results. I understand that should I have laser treatments my permanent makeup must be sufficiently covered with zinc oxide. I understand that my chosen procedure is permanent but due to factors such as health, medication and sun, the application may fade with time and touch-ups will be required at an additional cost. I understand that I have the option of receiving a patch-test prior to the procedure. If I waive the rights to such a test I will be fully responsible for any consequences of an allergy that may occur associated with the procedure. Depending on the procedure which I select I accept full responsibility for determining the colour, shape and position of the application. I undertake to follow the after-care procedures that have been given to me carefully and completely. I must notify Nadine’s Health & Skincare immediately if I have an infection, adverse or allergic reaction to procedure performed. I have been given the opportunity to ask questions about the procedure to be performed. I understand all the risk and hazards involved and I believe that I have sufficient information to give this informed consent.
Name & Surname
PLEASE READ AND INITIAL THE FOLLOWING:
I hereby give my consent to Nadine’s Health & Skincare to take photographs of the procedure and use them for advertising purposes.
I hereby authorise Nadine’s Health & Skincare to take photographs but to maintain on file only.
Date
I understand that the information I have received is not meant to scare or alarm me but to make me informed in order to give or withhold my consent.
I have agreed to the drawn shape and design that was done prior to my procedure.
I have informed Nadine’s Health & Skincare that I am in good health and not under special care of a physician that may compromise the procedure.
ACCEPTED BY:
Signature
Submit