Name____________________________________ Date____________

Phone______________________ email address___________________________________

MICROPIGMENTATION/ COSMETIC SEMI PERMANENT MAKEUP TREATMENT(“PROCEDURE”)

BEFORE & AFTER CARE INSTRUCTIONS

WHAT TO EXPECT IN THE HEALING PROCESS FOR ALL BROW ENHANCEMENT PROCEDURES

  • Remember, that no two sides of the face are the same or perfectly symmetrical. While trying to obtain perfect symmetry is our goal, note that nothing is PERFECT. In Some cases, Botox or a cosmetic medical procedure performed by a doctor may be required if the facial muscles on one side are too strong, and more than a very slight adjustment is required for perfect symmetry. ________Initial
  • When you leave the studio, your treated areas are intact. Remember your technician will do their best to help you heal properly but  lifestyle, genetics, age, and certain environmental factors can and will contribute to the retention of your procedure. ________Initial
  • It is common for some areas to fade more so than others. Unbalanced fading is to be expected as it occurs as part of the healing process. The goal of the recommended touch-up appointment is to correct any imperfections due to natural healing and natural skin exfoliation. People who still have previous permanent makeup showing may require color correction, which can take 1-3 treatments to achieve the desired result. If scar tissue is in the procedure area it may require multiple procedures which WILL require additional fees. ________Initial
  • Permanent Makeup is an art, NOT a science. All client results will vary. The use of makeup may still be needed after healed results. This is not a “no maintenance” treatment, it’s a “low maintenance” treatment. ________Initial
  • After your initial procedure has been completed and you return for your recommended touch-up appointment, if you change your mind and want a different procedure (for example, if you start with hair stroke eyebrows and decided you want ombre’ powder brows at your follow-up appointment), you will be charged based on the cost of the new procedure.  Additionally, you may be required to reschedule the appointment due to  any additional time required.  You will still be charged for any required touch-up visits. ________Initial
  • Recommended follow-up visits should be performed within 6-8 weeks after your initial treatment.  There is always a charge for the follow-up appointment for touch-ups.  ________Initial
  • While your skin heals, be prepared for  your color intensity from  your procedure to be SIGNIFICANTLY LARGER, SHARPER, BRIGHTER, OR DARKER than what is expected for the final outcome. Your color will oxidize and darken over the first few days. The area may appear uneven, dry, itchy, tender, red & irritated. During the exfoliation process, your color may look weak, orangey, pinkish, or grey but this will not be the final result. Your procedure area may not exfoliate evenly DO NOT PICK at the scabs Picking can lift color and pigment from the treated area resulting in unevenness and blank spots. Let the brows flake off naturally. The color CAN AND WILL fade/soften anywhere from10% to 50% or more. Some residual swelling is normal for ALL procedures. Blanching (whiteness around the treatment area) and redness is also to be expected. It can last a few hours to a few days. This is all normal and expected result of the procedure  and healing process. These symptoms will dissipate each day and vary on an individual basis..
  • The healing process will take several days to complete, depending on how quickly the outer layer of your skin exfoliates and new skin regrows to take its place but this also varies from client to client.Please be patient and wait until you are fully healed before you critique your eyebrows, eyeliner, or lips. Any refinements can be addressed at a follow-up visit.
  • You will need a color boost every 1-2 years to maintain its fresh natural appearance. Fading WILL happen after each procedure. After your healed results, you may still need to powder and/or pencil your eyebrows. Please not that we do not have control over your body’s healing process. ________Initial
  •  
  •  
  •  
  •  
  • .
  •  
  •  
  • If you are out in the sun a lot, have oily skin, use anti-aging creams, Retinol-A /retinol products, acidic cleansers, natural elements, regular chemical peels, or exercise frequently, your permanent makeup WILL fade prematurely. The better you take care of the treated area and follow the provided aftercare, the longer it will last. ________InitialBEFORE THE TREATMENT:
  • You must be off Accutane or any prescribed acne medications for 1 year. NO Exceptions! ________Initial
  • Do not take the following medications  3 days prior to your appointment unless medically necessary as  prescribed by a doctor:  Aspirin, Fish Oil, Niacin, Vitamin E, and/or Ibuprofen or blood thinners. Tylenol is allowed. ________Initial
  • Do not drink coffee, alcohol, or energy drinks on the day before and the day of the procedure. This is important to minimize any bleeding or swelling after the procedure. ________Initial
  • If you normally get your brows tinted, do it at least 7 days  prior to the procedure. It is recommended to not tint eyebrows for at least 30 days after a procedure. ________Initial
  • Do not tan or sunbathe 30 days before and after the procedure. ________Initial
  • If you normally get your eyebrows waxed or threaded, please have this done at least  3 daysprior to your scheduled procedure. It is recommended to wait at least 14 days to have them waxed or threaded after the procedure. ________Initial     
  • Do not undergo any of the following treatments for at least 21-28 days  before a procedure: Chemical peeling, microdermabrasion, mesotherapy, or any other intense treatment which will cause faster skin cell rejuvenation or cause skin Irritation. Again, avoid these treatments for21-28 days  before a procedure. ________Initial
  • It is recommended to keep the procedural area dry for 10 days after a procedure, so it is important to wash your hair before the procedure. ________Initial

Semi-Permanent Make-Up Consent Form

 Name____________________________________   Date______________

The nature and method of the proposed cosmetic semi-permanent make-up procedure(s) have been sufficiently explained to me by a licensed tattoo professional, including the usual risks inherent in the procedure , and the possibility of complications during and after  the procedure(s). I understand there may be a certain amount of discomfort or pain associated with the procedure(s) and that there may be other adverse side effects including but not limited to minor and temporary bleeding, bruising, swelling, or redness,  discolorations or loss of pigment.. Due to swelling, unevenness may occur in the tattoo area  Secondary infection around the tattoo area may also occur; however, adherence to the written after-care instructions provided by thelicensed tattoo professionals will help minimize such  occurrences. ___________(Initial)  

  • I am not pregnant. ___________ (Initial)
  • I am not under the influence of alcohol and/or drugs. ___________ (Initial)
  • I acknowledge that complications as a result of the  procedure (s) may include infection, particularly in the event my post-procedural instructions are not followed. ___________ (Initial)
  • I do not have medical or skin conditions such as, but not limited to acne, scarring (Keloids), eczema, psoriasis, freckles, moles, or sunburn in the area to be tattooed that may interfere with the said tattoo. I do not have an infection or a visible rash anywhere on my body, I have advised my technician of any potential skin concerns. ___________ (Initial)
  • I acknowledge it is not reasonably possible for the technician to determine whether I might have an allergic reaction to the pigments or processes used in my tattoo, and I agree to accept the risk by waiving a patch test and understand that such a reaction is possible. If I want a patch test, I understand it will take 24 hours to determine my eligibility for the said tattooing and I must inform the technician before signing this agreement. ___________ (Initial only if waiving a test patch)
  • It has been explained to me, immediately after the procedure(s) is completed, my skin  color on the tattoo area will appear darker and bolder. It has also been explained to me that within a short period of time (usually 5-7 days) during the healing process, the said color will lighten/soften, and the tattoowill heal and become softer than it was on the procedure date. (Please do not pick any scabs and be aware pigment can stain clothing and sheets). ___________ (Initial)
  • I acknowledge that hyper-pigmentation (darkening of the skin) or hyperpigmentation (absence of color in the skin), or scarring is a possibility as a result of my body’s reaction to the skin beingbroken during the procedure.
  •  
  • I realize that my body is unique and that the technician cannot predict how my body will react as a result of this procedure. ___________ (Initial)
  •  
  • I acknowledge that the procedure(s) will result in a permanent change to my appearance and that no representations have been made to me as to the ability to later change or remove the results. I understand tattoo removal is a surgical procedure that may cause scarring and/or disfigurement. _______ (Initial)
  • I understand that future laser treatments, plastic surgery, implants, injections, and other skin-altering procedures may alter and degrade my cosmetic tattoo procedure(s). I further understand that such changes are NOT the responsibility of the technician, and such changes in my appearance may NOT be correctable through further cosmetic tattoo procedures. ___________ (Initial)
  • I understand that tattoos may cause MRI (Magnetic Response Imaging) artifacts and that there may be a warming and/or tingling sensation in the tattooed area during an MRI due to the iron oxide properties of some pigments. It is understood that I should advise my physician that I do have permanent cosmetics (a tattoo) in the event an MRI procedure is prescribed. ___________ (Initial)
  • I authorize the technician to obtain pre-procedural and post-procedural pictures and give permission to use such pictures for publication and/or teaching purposes, as they choose. ___________ (Initial)
  • I acknowledge the receipt of written instructions advising me of the proper care for my procedure(s), and receipt of ointment from the technician. I understand the absolute necessity of following these instructions. ___________ (Initial)
  • I understand that cosmetic tattooing is an art form and NOT an exact science, and I acknowledge that NO guarantees have been made to me in relation to  the procedure. It has been explained to me that some skin types will not accept or heal pigment in a consistent manner and that skin type and skincare will determine my results. I realize that my body and my skin are unique and that the technician cannot in any way predict how my skin may react to the procedure or how it may or may not accept color. A touch-up appointment has been recommended and encouraged. I also realize that the technician cannot predict how many visits it will take to complete my procedure. ___________ (Initial)
  • I accept full responsibility for determining the color, shape, and position of the pigments that will be applied. I understand the actual healed color of the pigment applied will be modified slightly due to my own unique skin undertones. ___________ (Initial)
  • This contract is to remain in effect from the date of my signing and its contents are to still apply whenever the work is being performed on myself by the technician. It is my responsibility to inform the technician if any changes have occurred in my medical history. ___________ (Initial)
  • I have read, understood and agree to be legally bound by the contents of each paragraph above.

* If you are receiving services by an apprentice, skip this page and please proceed page 5.

I, (print name) _____________________________________, acknowledge by signing this consent form, that I have the capacity to contract herein and I do so freely and voluntarily and that I been given the full opportunity to ask the technician any and all questions about cosmetic tattooing procedure(s), its process, and the risks involved to my satisfaction. The decision to have cosmetic tattooing procedure(s) performed is my own and I understand and accept all risks involved, therefore releasing Makoto L. Suzuki, SUZUKOO HAWAII.JAPAN, LLC (DBA SUZUKOO Relaxation & Skin Design), and any employee or contract employee of any and all legal liability. In consideration of the tattoo procedure performed on me, I hereby release and forever discharge Makoto L. Suzuki and her employees both personally and under the business name of SUZUKOO HAWAII.JAPAN, LLC (DBA SUZUKOO Relaxation & Skin Design) from all claims, demands, actions, and causes of actions arising out of said treatment procedures which I, my heirs, executors, administrators, assigns or any party who may claim through me may have stemming from my decision to have either a Permanent Makeup procedure and/or an Areola/Nipple procedure. I agree that this waiver also pertains to and is designed to protect any and all establishments where Makoto L. Suzuki does business. The technician is a trained, experienced, and skilled artist, or a licensed apprentice that is supervised by an experienced and skilled artist, who makes no claims to be anything more. Permanent makeup/cosmetic tattooing is not a medical procedure but is an art form: the art of tattooing.

Any and all fees are to be paid prior to or on the day of the procedure and are nonrefundable.  

Client’s Print name:                                                                                                                                                              

Client’s Signature: Date:                                                      

Technician’s Print name               Makoto L. Suzuki                                                        

Technician’s Signature: Date:                                                               

Signature of parent or legal guardian if the client is under 18 years of age:

Date:                                                                

 AGREEMENT TO RECEIVE SERVICE PERFORMED BY AN APPRENTICE

I, (print name) _____________________________________, acknowledge by signing this consent form, that I have the capacity to contract herein and I do so freely and voluntarily and that I have been made aware that the technician performing my cosmetic tattoo procedure(s) is an apprentice and not an experienced technician. I understand the apprentice is licensed to perform tattoo procedures in the State of Hawaii and has completed a training program that includes working on live models. I have personally chosen to receive service by an apprentice in training for a discounted price. The decision to have cosmetic tattooing procedure(s) performed by an apprentice is my own and I understand and accept all risks involved, therefore releasing Makoto L. Suzuki, SUZUKOO HAWAII.JAPAN, LLC (DBA SUZUKOO Relaxation & Skin Design), and any employee or contract employee of any and all legal liability. In consideration of the tattoo procedure performed on me, I hereby release and forever discharge Makoto L. Suzuki and her employees both personally and under the business name of SUZUKOO HAWAII.JAPAN, LLC (DBA SUZUKOO Relaxation & Skin Design) from all claims, demands, actions, and causes of actions arising out of said treatment procedures which I, my heirs, executors, administrators, assigns or any party claiming through me may have stemming from my decision to have either a Permanent Makeup procedure and/or an Areola/Nipple procedure. I agree that this waiver also pertains to and is designed to protect any and all establishments where Makoto L. Suzuki does business. The technician is a trained, experienced, and skilled artist, or a licensed apprentice that is supervised by an experienced and skilled artist, who makes no claims to be anything more. Permanent makeup/cosmetic tattooing is not a medical procedure but is an art form: the art of tattooing.

Any and all fees are to be paid prior to or on the day of the procedure and are nonrefundable.

Client’s Print name:                                                                                                                                                              

Client’s Signature: Date:                                                      

Technician’s Print name                                                                   

Technician’s Signature: Date:                                                               

Signature of parent or legal guardian if the client is under 18 years of age:

Date:                                                                

At Legal writing experts, we would be happy to assist in preparing any legal document you need. We are international lawyers and attorneys with significant experience in legal drafting, Commercial-Corporate practice and consulting. In the last few years, we have successfully undertaken similar assignments for clients from different jurisdictions. If given this opportunity, The LegalPen will be able to prepare the legal document within the shortest time possible. You can send us your quick enquiry ( here )