Effortless Beauty Clinic: Consent Form
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Please initial in response to each question or statement.

I, being of sound mind, acknowledge by signing this agreement that I have been given the full opportunity to ask any and all questions which I might have about the obtaining of an intradermal cosmetic tattoo and that all of my questions have been answered to my full satisfaction. I specifically acknowledge I have been advised of the facts and matters set forth below and I agree as follows:

_____ If I have any condition that might affect the healing of this cosmetic tattoo, I will advise my technician. There may be unknown allergies or conditions, but I accept the risk for any unknown allergies or conditions. I am not pregnant or nursing. I am not under the influence of alcohol or drugs.
I do not have medical or skin conditions such as but not limited to: acne, scarring (Keloid) eczema, psoriasis, freckles, moles or sunburn in the area to be tattooed that may interfere with said cosmetic tattoo. If I have any type of infection or rash anywhere on my body, I will advise my technician. *
I acknowledge it is not reasonably possible for the representatives and employees of Effortless Beauty Clinic to determine whether I might have an allergic reaction to the pigments or processes used in my cosmetic tattoo, and I agree to accept the risk that such a reaction is possible. Otherwise, I will request a patch test, and I release the technician from any liability resulting from said procedure(s). *
I acknowledge that infection is always possible as a result of the obtaining of a cosmetic tattoo, particularly in the event that I do not take proper care of my procedure site. I have received aftercare instructions and I agree to follow them while my cosmetic tattoo is healing. I agree that any touch-up work needed beyond the pre-agreed upon sessions, due to my own negligence, will be done at my own expense. *
I realize that variations in color and design may exist as ultimately applied to my body. I understand that if my skin color is dark, the colors will not appear as bright as they do on light skin. *
I understand permanent cosmetics may be affected by skin treatments, laser hair removal, plastic surgery or other skin altering procedures may result in adverse changes to my cosmetic tattoo. I acknowledge some of these potential adverse changes may not be correctable. *
I understand the Effortless Beauty Clinic, it’s representatives, and employees are not medical professionals. *
I acknowledge that a cosmetic tattoo is a (semi)permanent change to my appearance and that no representations have been made to me as to the ability to later change or remove my cosmetic tattoo. To my knowledge, I do not have a physical, mental or medical impairment or disability which might affect my well being as a direct or indirect result of my decision to have a tattoo. *
I acknowledge I am over the age of eighteen and that I have truthfully represented to my technician that the obtaining of a cosmetic tattoo is by my choice alone. I, being of sound mind, consent to the application of the cosmetic tattoo and to any actions or conduct of the representatives and employees of Effortless Beauty Clinic reasonably necessary to perform the tattoo procedure. *
I acknowledge, understand, and agree that in no event shall deposits, booking fees, tips, and/or monies paid for Effortless Beauty Clinic services be refunded to me or my representative. *
I have been informed of the nature, process, and adverse effects of permanent skin pigmentation. Based upon skin type and lifestyle, this procedure may result in varying degrees of, including but not limited to: infection, scarring, color change, and spreading, fanning or fading of pigments. *
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