The nature and method of the proposed permanent makeup cosmetic tattoo procedure has been explained to me by Pixel Beauty LLC and my technician, including the usual risks inherent in the procedure process, and the possibility of complications during or following its performance.
I understand there may be a certain amount of discomfort or pain associated with the procedure and that other adverse side effects may include minor and temporary bleeding, bruising, redness or other discoloration and swelling. Fading or loss of pigment may occur. Secondary infection in the area of the procedure may occur; however, if properly cared for, is rare.
I understand that a skin test of the pigment is offered upon request, and the test result is not viewed by a medical professional unless I make arrangements to have this done myself. A non-reactive skin test does not preclude an allergic reaction occurring at a future point in time.
I am 18 years or older and have informed my technician of any existing health problems.
I acknowledge that complications are always possible as a result of the permanent makeup procedure, particularly in the event my post-procedural instructions are not followed.
I acknowledge that hyper-pigmentation (darkening of the skin) or hypo-pigmentation (the absence of color in the skin), or scarring is a possibility as a result of my body’s reaction to the skin being broken during the procedure. I realize that my skin and body is unique, and my technician cannot predict how my skin may react as a result of this procedure.
I acknowledge the receipt of written instructions advising me of the proper care of my procedures, and I recognize the absolute necessity for following these instructions.
I acknowledge that the procedure 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 that future laser treatments or other skin altering procedures, such as plastic surgery, implants and injections may alter and degrade my permanent makeup.
I further understand that such changes are not the responsibility of Pixel Beauty LLC or my technician.
I further understand that such changes in my appearance may not be correctable through further permanent makeup procedures.
I am aware that cosmetic tattooing is not an exact science, and I acknowledge that no guarantees have been made to me as to the results of the procedure.
I authorize my technician and Pixel Beauty LLC to obtain pre-procedural and post-procedural photographs and give them permission to use such photographs for publication and/or for teaching
I understand that tattoos may cause MRI (Magnetic Resonance Imaging) artifacts and that there may be a warming and/or tingling sensation in the permanent cosmetic procedural area during the 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.
The fee for permanent makeup services has been explained to me and has been agreed upon. I understand the total fee for services rendered is due upon completion of the initial procedure(s) and that there will be separate fees for any future modification of the design or color.
I acknowledge that since my approval is obtained prior to the final selection of color to be implanted and design application(s) to be applied, Pixel Beauty LLC has a no refund policy.
I acknowledge that for some skin types, permanent makeup may be a multi-session process and there are separate fees for each session. Following your initial application, you will be entitled to a post-evaluation appointment. At the post-evaluation appointment, your technician will determine if a touch-up to the initial application is required and the cost. I am responsible for scheduling the post evaluation appointment within 45 days after the initial procedure.
It has been explained to me that immediately after the procedure(s) is completed, the color will appear darker than when the procedure heals. It has also been explained that within a short period of time, during the healing process, the color will lighten.
If removal services is performed on you, Pixel Beauty LLC and your technician do not guarantee the success of removal and or corrective procedures due to the large number of variables that affect the success of such procedures.
I hereby agree to waive and release to the fullest extent permitted by law Pixel Beauty LLC and its technicians from all liability whatsoever, for any and all claims or causes of action that I, my estate, heirs, executors, or assigned may have for personal injury or otherwise, including and direct/and or consequential damages which result or arise from the application of my permanent makeup, whether caused by negligence or fault of Pixel Beauty LLC or its technicians. I agree that any liability of Pixel Beauty LLC and my technician is limited to the cost of the procedure performed. In the event of disputes that cannot be amicably resolved, Pixel Beauty LLC, the technician, and I agree to binding arbitration in Washington State to resolve any and all disputes.
I have read and understood the contents of each paragraph above. I have received no unrealistic warranties or guarantees with respect to the benefits to be realized from, or consequences of, the aforementioned procedure(s). I acknowledge Pixel Beauty LLC and my technician make no attempt to, or claim to, practice medicine.
I acknowledge by signing this consent form, have been given the full opportunity to ask any and all questions about permanent makeup procedure(s) and process(es) from Pixel Beauty LLC and my technician.