Please read and initial all lines:
1- Aftercare instructions have been explained to me and a written copy will be given to me to retain in my possession, which I will follow to the best of my ability. If I have questions I will call or email my technician.
2- I understand that a certain amount of discomfort is associated with this procedure and swelling, redness, and bruising may occur.
3- Fever blisters may occur in lip procedures in individuals who have the herpes simplex virus and it is my responsibility to obtain a prescription from my doctor for an anti-viral medication to help avoid a breakout.
4- I understand that Retin-A, Renova, Alpha Hydroxy, and Glycolic Acids must not be used on the treated areas. They will alter the color.
5- I understand that sun, tanning beds, pools, some skin care products, and medications can affect my permanent makeup.
6- I understand that successful lip color saturation can NOT be guaranteed due to hidden scar tissue.
7- I will tell all skin care professionals or medical personnel about my permanent makeup procedures, especially if I’m scheduled for an MRI.
8- I accept the responsibility to explain to you my desire for specific colors, shape, and position for any procedures done today.
9- I understand that implanted pigment colors can slightly change or fade over time due to circumstances beyond your control and I will need to maintain the color with future applications and a touch up session within 60 days.
10- 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, misplaced pigment, poor color retention, and hyper-pigmentation.
11- I have been quoted the cost of today’s appointment. After 30 days; a fee will apply and there will be no refunds for this elective procedure(s). I certify that I have read or have had read to me the contents of this 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 and I authorize, Samira Azish, as my permanent cosmetics technician to perform on my body the following procedures: