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MEDICAL HISTORY CLIENT & CONSENT

Please Read The Following Carefully:

• This treatment is a form of tattooing.

• Touch-up procedures may be required.

• You must wait between 6 to 12 weeks before an enhancement session can be performed.

• In rare cases the pigment may migrate under the skin.

• The pigment will fade overtime.

• Immediately after the treatment, the pigment can be 30% to 50% darker than the desired result.

• There may be immediate or delayed allergic reaction to pigments. However, an allergic reaction is extremely rare.

• Infections can occur. If so, contact your physician.

• Allergic reactions to anesthetics can occur.

• There may be swelling and redness following the procedure.

• You may experience minor bleeding.

• Those receiving treatment for eyeliner should have someone drive them home, it is recommended but not mandatory.

• Corneal abrasion may occur during eyeliner procedures. However, corneal abrasion is rare.

• If you have had previous problems with cold sores/herpes and wish to receive a lip treatment, you may have a recurrence of cold sores following the procedure. Antiviral medication is available over the counter or by prescription and has been shown to prevent or minimize such outbreaks.

• Lip treatments will appear dry and flaky for one week following the procedure.

• If you have an MRI scan within 3 months of your cosmetic tattoo procedure, it is recommended that you discuss this with your doctor.

• Possible scarring and inconsistency of color may occur. 

MEDICAL HISTORY
Are you currently under the care of a physician?
Have you ever had an allergic reaction to any of the following? (Please check those that apply to you)
Metals Such As
Do you have or have you had any of the following medical conditions? (Please check only those that apply to you)
Do you suffer from eye Infections?
Chemical or laser peel within 6 months?
Accutane within 6 months?
Do you scar in a raised manner?
Do you have Healing Problems?
Have you used Retin A within 6 months?
Had steroids within 6 months?
Have you had chemical peels within the last 2 weeks?
Do you tan regularly?
Do you have previous cosmetic tattooing?
PLEASE READ AND SIGN

Please fill out the client consent form to the best of your knowledge. We reserve the right to refuse and undertake any permanent cosmetic makeup procedure if it is deemed unsuitable or unsafe to the client. We’re delighted you have chosen our services. If requested, we will provide proof of your artist certification.

 

You hereby release Posh Beauty Artistry, from any and all liability for any injury, including, without limitation, personal, bodily, or mental injury, economic loss or any damage to you resulting from your use of Posh Beauty Artistry services. As well as liability arising from any such injury or damage resulting from your failure to disclose any pre-existing condition, limitation, or specific sensitivities, or your failure to inform your artist of any discomfort during the session. Your artist may determine that it is unsafe for you to proceed with or continue a permanent cosmetic makeup session for any reason.

am over the age of 18, am not under the influence of drugs or alcohol and desire to receive the indicated cosmetic tattooing procedure. The general nature of cosmetic tattooing as well as the specific procedure to be performed has been explained to me. 

I have been informed of the nature, risks, and possible complications and consequences of permanent skin pigmentation. I understand the permanent skin pigmentation procedure carries with it known and unknown complications and consequences associated with this type of cosmetic procedure, including but not limited to: infection, allergic reaction, scarring, inconsistent color, and spreading, fanning, or fading of pigments. I understand the actual color of the pigment may be modified slightly, due to the tone and color of my skin. I fully understand this is a tattoo process and therefore not an exact science, but an art. I request the permanent cosmetic makeup procedure(s), and accept the permanence of the procedure as well as the possible complications and consequences of the said procedure(s).

I understand that if I have any skin treatments, laser hair removal, cosmetic surgery or other skin altering procedures, it may result in adverse changes to my permanent cosmetics. I acknowledge some of these potential adverse changes may not be correctable.

I have received the pre- and post-procedure instructions and I will strictly adhere to such instructions. I understand that my failure to do so may jeopardize my chances for a successful procedure.

If I am on any medication for depression or any other mood altering prescription,

I will advise my artist. If I have ever had cold sores, I will consult with and strictly follow my doctor's instructions before contemplating any cosmetic tattooing procedure around my lips. 

• I hereby authorize my cosmetic tattoo artist Posh Beauty Artistry to perform upon myself the following procedure(s): Cosmetic Brow Tattoo? Cosmetic Lip Tattoo? Cosmetic Eyeliner Tattoo?

• If any unforeseen condition arises in the course of this procedure(s), calling in her judgement in addition to, or different from those now contemplated, I further request and authorize him/her to do whatever she deems advisable and necessary in the circumstances.

• I fully understand, as with all such procedures that this is not a science but rather an art. Depending on the procedure(s) selected, I accept responsibility for determining the color, shape and position of eyebrows, eyeliner, lip tattoo or other as agreed during the course of my consultation.

• I fully understand and accept that non-toxic pigments are used during the procedure(s) and that the cosmetic enhancement achieved may fade in between one to three years. Even though the color has faded the pigment will stay in the skin indefinitely.

• I have been informed that the highest standard hygiene is met, and that sterile disposable needles, and pigment containers are used for each individual client, procedure, and visit.

• I understand and accept that each procedure is a process requiring multiple applications of pigment to achieve desirable results, and that 100% success cannot be guaranteed. I understand that this is why I need to return for a touch-up procedure.

• I understand that an enhancement procedure will be performed between 6 to 8 weeks after the initial procedure. I understand that future touch-up’s will be charged an additional fee for any further work. I will book the appointment when it is convenient for both parties.

• The result of the procedure is determined by the following:

1. Medication

2. Skin Characteristics (dry, oily, combinations, sun-damaged and thickness)

3. Natural skin undertones (blending with chosen pigment)

4. Personal pH balance of skin, which changes from visit to visit

5. Alcohol intake and smoking 6. Following pre + post care instructions g.

• Upon completion of the procedure there may be swelling and redness of the skin, which will subside in between one to four days. In some cases, bruising can occur. Clients may resume normal activities immediately following the procedure, however, using cosmetics, exercise, excessive perspiration, and exposure to the sun on the affected area should be limited. See specific post-care instructions for details. Clients can, however, be assured that the procedure, even after only one treatment, appears acceptable and that they can appear in public without additional makeup on the affected area.

• I have been advised that the true color will be seen between 4-6 weeks after each procedure, and that the pigment may vary in color according to skin tones, skin type, age, and skin conditions.

• I understand that some skin types accept pigment more readily than others and no guarantee to an exact effect or color can be given.

• I am aware that the lip procedures may stimulate any dormant virus such as herpes (cold sores) which is why I am asked to take an antiviral medication prior to and post procedure.

• I am informed that eye procedures may stimulate dormant eye disorders or eye infections, and that some medications and oils can prevent absorption of the pigment. 

• To my knowledge I do not have any physical, mental, or medical impairment or disability that might affect my well-being as a direct or indirect result of my decision to have the procedure done at this time.

● I am at least 18 years old. I do not have a heart condition. I do not have epilepsy. I have not had hepatitis within the last year. I am not hemophiliac. I do not have HIV. I am not under the influence of drugs or alcohol.

● I agree to follow all pre-care and post-care instructions as provided and explained to me by my artist

● Being of sound mind and body, I hereby release any and all responsibility for any consequence that might stem from my decision to have any cosmetic tattooing performed by my artist at Posh Beauty Artistry.

• For the purpose of documentation, I understand that the taking of before and after photographs of the said procedure(s) is a condition of such procedure(s).

• I accept full responsibility for the decision to have this cosmetic tattoo work done.

● I certify that I have read, and have had explained to me, and fully understand the above consent; that the explanations therein referred to were made, and I accept full responsibility for these and or other complications which may arise or result during or following the permanent cosmetic / tattoo procedure(s) which is / are to be performed at my request according to this consent and procedure permit, that all blanks or statements requiring insertion or completion were filled in before I signed.

I have read and fully understand the above information

I have read and understand the above information. To the best of my knowledge, I have answered every question completely and accurately. I will inform my technician of any change in my health and/or medication:

sign to say the brow tattoo, eyeliner tattoo, lip tattoo design created prior to my procedure is a true picture of what I want, as well as my artist’s expertise on what will look best on me. I also consent to digital photos and videos being taken before and after my treatment so that there is a true comparison between what was requested and what was delivered.

Thanks for submitting!

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