Please ensure that you read this form carefully and understand any risks that may result from this treatment. Please feel free to ask any questions before, during and after treatments with us. You have the right to change your mind about receiving treatment including after signing this form.
I have been given the opportunity to ask questions about the treatment and I'm happy with the answer given by the therapist.
I hearby authorise technician Camelia Solescu to perform upon myself cosmetic enhancement. If any unforseen conditions arise in the course of the procedure(s) I further request and authorise her to use her full judgement and do whatever she deems advisable and necessary in the circumstances.
I understand that permanent cosmetic enhancement is a form of tattooing. I accept responsibility for determining the colour, shape and position of the enhancement as agreed during the course of my consultation.
I understand that sensitivity test for pigment does not guarantee that I will not have an allergic response. I am aware that allergic response to pigment is rare and accept all responsibility if an allergic response occurs. I have had a patch test and there was no reaction.
I am aware that sensitivity reaction can occur to any of the products used and accept all responsibility if allergic response occurs.
I fully understand and accept that non-toxic pigments are used during the procedure and that the cosmetic enhancement achieved may fade over the course of 1-3 years. Even though the colour has faded, the pigment will stay in the skin indefinitely and may leave a light residue of colour.
I accept that the highest standards of hygiene are met, and that sterile disposable needles 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 control procedure.
I understand that the control procedure, if required, will be performed 1-3 months after the initial procedure and that after a 3-month period I will be charged an additional fee for any procedures.
I understand that a control procedure takes place 4 weeks after the initial application to allow the procedure site to fully heal. I will book the appointment when it is convenient for both parties.
I understand that the pigment may migrate under the skin, however this is a rare occurrence.
I understand that permanent cosmetic enhancement is an invasive procedure and the infusion process can be uncomfortable.
I understand that loss of any eyelashes or eyebrow hair during the healing of permanent cosmetic eye enhancements will result in new eyelash, brow growth over a 4 month period and that eyelash loss is rare and minimal.
I understand that in rare cases that corneal abrasion can occur during eyeliner procedures.
I am aware that The result of the procedure is determined by the following:
Medication/Skin Characteristics i.e. dry/oily/sun-damaged/Natural skin undertones/Alcohol intake and smoking/General stress/A compromised immune system/Poor diet/Post procedure care treatment
I have been advised that upon completion of the procedure there may be swelling and redness of the skin, which will subside within 1-4 days dependent on lifestyle. In some cases bruising can occur.
I have been advised that I can resume normal activities immediately following the procedure, however, using cosmetics, prolonged exposure to water, excessive perspiration and exposure to the sun should be limited for up to two weeks following the infusion process.
I understand that immediately after the procedure the enhancement can be 50 to 60% darker than the desired result and can take between 4-10 days to lighten.
I understand that the true colour will be visible 1 month after each application, and that the colour may vary according to skin tones, skin type, age and skin conditions.
I appreciate that some skins accept colour more readily than others and no guarantee of an exact effect or colour can be given.
I am aware that that if I have had a previous eye disorder or eye infection and receive an eyelash enhancement, the disorder may reoccur again. I agree to use the correct medication to prevent such a disorder reoccurring.
I am aware that if I have had a previous outbreak of cold sores/herpes and receive a lip enhancement I may have an outbreak again following the procedure. I have been made aware that anti herpes medication is available over the counter or on prescription and has been shown to prevent or minimise such outbreaks.
I am aware that even though my vision is not affected by permanent cosmetic eye enhancements I may wish to have someone drive me home.
I understand that I may experience dry lips for up to two weeks following permanent cosmetic lip enhancement.
I understand that there are few effective methods for pigment removal. Laser removal has proven successful, however is a process.
I agree to inform my doctor of my permanent cosmetic enhancement if I require a MRI scan within a 3 month period of receiving the procedure.
I agree to follow all pre-procedure and post-procedure instructions as provided and explained to me by the practitioner. I understand that infection and possible scarring can occur if I do not adhere to the said instructions.
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 am not under the influence of drugs or alcohol.
For the purpose of documentation, I also consent to the taking of “before” and “after” photographs of said procedure(s) to be used for marketing.
I declare that I give my full consent to the tattooing being carried out by the aforementioned practitioner. I confirm that potential complications, e.g. infection and swelling, for the procedure undertaken, and aftercare instructions have been explained to me. A written aftercare advice sheet containing more detailed information has been given.
I confirm that I am over the age of 18, I am not under the influence of drugs or alcohol.
I certify that I have been fully informed of the nature and purpose of the procedure, expected outcomes and possible complications, and I understand that no guarantee can be given as to the final result obtained. I am fully aware that my condition is of cosmetic concern and that the decision to proceed is based solely on my expressed desire to do so. I accept that should I proceed with treatment against the advice of my therapist, that I accept full liability for any issues that may arise.
I confirm that I have informed the staff regarding any cursor past medical condition, disease or medication taken.
I confirm that by signing below I have read and fully understand this consent form and I’m happy to go ahead with the proposed treatment.
I confirm that in the event of an adverse reaction, I will notify the technician within 24 hours and follow advice given by the technician, and that, if advised, I will consult my GP and seek medical attention.