Permanent Makeup Touch-Up Informed Consent

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Today's Date: *

YYYY

First & Last Name: *

Email: *

Phone Number: *

Date of Birth: *

YYYY

Procedure: *

Microblading/Brows

Scalp micro pigmentation

Areola micro pigmentation

Freckles/Beauty Mark

Lip Blushing

Artist: *

Shannon M

Guest Artist

Required

By checking the following: *

I understand that my procedure is sem-permanent and additional touch-ups are likely needed every 6 months to 2 years to maintain my permanent makeup.

I understand that any further touch-ups after this appointment will be at an ADDITIONAL COST.

I understand that implanted pigment color can slightly change or fade over time due to circumstances beyond my control and I will need to maintain the color with future touch-ups that will be at an additional cost as previously stated.

I understand the aftercare instructions that have been given which I will follow to the best of my ability to maintain my desired look. If I have questions, I will call or email my artist.

I understand that Retin A, Renova, Alpha Hydroxy, Glycolic Acids, laser treatments, chemical peels, and micro needling must not be used on treated areas. They will alter the color and cause premature exfoliation of the pigment.

I understand that tanning beds, sun exposure, some skin care products and medications can affect my permanent makeup.

I accept the responsibility to explain my desire for specific colors, shape, and position for any procedure done today.

I understand that the use Botox or any other fillers may affect the symmetry of my permanent makeup.

I have informed my artist of any new medical conditions or allergies since my initial appointment.

Required

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