English Permanent Makeup Service

FirstLast

FirstLast

• Hypertension
• Heart issues
• Rashes
• Diabetes
• Problems healing wounds
• Blood Clotting or history of hemphelia
• History of keloid scarring
• History of cold sores or fever blisters
• History of anemia
• Seizure
• History of skin disease or skin sensitivity
• Pregnant/Breastfeeding

• Yes
• No

• I acknowledge I am age 18 and older
• I will tell all skin care professionals or medical personnel about my permanent makeup procedures. I understand that any skin treatments i.e. Retin A, Renova, Alpha Hydroxy and Glycolic Acids, laser hair removal, plastic surgery, or other skin altering procedures may result in adverse changes to my permanent makeup. I understand that sun, tanning beds, pools, some skin care products and medications can affect my permanent makeup.
• I understand that successful color saturation can NOT be guaranteed. I acknowledge that the proposed procedure(s) involve risks inherent in the procedure and have possibilities of complications during and/or following the procedures such as: infection, poor color retention and hyper-pigmentation.
• I accept the responsibility of explaining to you my desire for specific colors, shape, and position for any procedure done today.
• I understand that after my service, there will be no refunds. No exceptions.
• All followup sessions must be completed no later than 45 days from initial session. Failure to make this appointment will incur additional costs corresponding to the amount of time that has passed since the initial session.
• I understand that implanted pigment color can slightly change in color or in shape and fade over time due to circumstances beyond my artist control. I will need to maintain my desired results with future applications at my own expense.
• If I have any signs and symptoms of infections I will seek medical care. These include but are not limited to: redness, swelling, tenderness of the procedure site, red streak going from procedure site towards the heart, elevated temperature, or purulent drainage from the procedure site.
• I grant permission to DaniBrowArtist, to take and use: photographs and/or digital images of me for use in news releases, educational materials and/or social media platforms including but not limited to Instagram, Facebook, and Pinterest. If no photo please inform your your artist.
• I acknowledge that this procedure may alter my appearance and that no representations have been made to me as to remove my permanent makeup. To my knowledge I do not have a physical, mental, medical impairment or disability which might affect my well being as a direct or indirect result of my decision to have permanent makeup.
• I acknowledge it is not reasonably possible for my technician to determine whether I might have an ALLERGIC reaction to the pigments, anesthetic or ointment used in this process. I agree to forego a patch test and accept the risk that such reaction is possible.
• I certify that I have read or have had read to me the contents of this whole 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.
• By selecting the “Submit” button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this Agreement.