Permenant Make up - Consent Form

 Marketing

We would like to contact you with special offers, related products and relevant services. If you consent for this purpose, tick you preference:

Photographs taken shall be part of the medical record and used for documentation of response to treatment. With explicit permission these photographs may also be used for educational purposes or for client information.

As part of the marketing activity (digital and/or print) we would like to use anonymously before & after photos of your treatment for use to promote this treatment.

Please read the following information carefully

• All forms of Microblading, Permanent Makeup (PMU) also known as Semi-Permanent Makeup (SPMU) or Micro pigmentation are forms of tattoo which uses pigment instead of ink. As the pigment molecules are smaller, they break down and fade over time, which means future refresh top-ups will be required to maintain the desired look.

• All Top-Ups must be performed a minimum of 6-8 weeks after the initial procedure and a maximum of 12 weeks after the initial treatment. 

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

• Pigments will fade over and will require Refresh Top-Ups after a minimum of 10 months.

•  Immediately after the initial procedure, the pigment will appear more vibrant and darker and will soften following the healing process

•  Sensitivity tests are performed for pigment and anaesthetic products. A sensitivity test does not guarantee a possible delayed reaction in extremely rare cases.

• There will be minor swelling and redness following treatment.

•  All Pre-Procedure and Aftercare instruction and Advice must be followed for safety, protection from infection, skin health and pigment retention.

• You must complete this form in full and hand it back for us to sign and authorise prior to you having any Microblading or micropigmentation procedure

•  If we advise you against having a procedure done, or if you disclose a medical condition which we feel may require a medical referral, you will be asked to seek authorisation from you GP before the procedure can be done. We will not be held liable as a result of any information or medical conditions that you fail to disclose under any circumstances.

• Refunds will not be given under any circumstance unless dissatisfaction has arisen from the unlikely event of Technician negligence.

• We do not exclude liability for any liability incapable of being excluded at law.

Medical Health Form

General Disclosure and Consent Form

STATEMENTS - Please read and SIGN to agree to the statements below.

1.    I am 18 years old and above

2.    I do not have any physical, mental, medical impairment or disability that may affect my ability to decide whether or not to have a procedure done. I am not under the influence of alcohol or drugs. 

3.    I have disclosed any relevant medical conditions by completing the ’Medical Health’ form.

4.    I authorise the technician stated above to perform the procedure(s) listed above on myself.

5.    I will follow the pre-procedure advice provided to me.

6.    I confirm that I have had a sensitivity patch test prior to the procedure and that I understand that an adverse reaction is extremely rare and may arise following treatment even if the sensitivity test did not result in any reaction.                                                              

7.    We want to manage your expectations, so please understand and appreciate that the results you get at the end of the procedure may vary from individual depending on a number of varying factors, namely; the skill of the technician; the colour pigment blended with your natural skin tone (and eyebrow hair); the shape and position of your procedure will be mathematically calculated and in  proportion to your facial structure; any medication  that you are taking; your skin characteristics (oily/dry/combination/sensitive/thick/thin/sun-damaged); the PH balance of your skin; diet; alcohol consumption; smoking intake; and any post-operative care treatment (if applicable). If the end results are not what are expected, you have no rights to make request for changes, unless the technician is in agreement to do so.

8. I accept that it will be the professional judgement and expertise of the technician that will design the shape, choose the appropriate pigment colour choice and positioning. 

9. I have been informed of the application procedure for Micro Pigmentation /PMU prior to the treatment. I understand that only non-toxic and hypoallergenic pigments will be used during the treatment and multiple applications of pigment may be required to try achieve the desired result. For this reason, I understand that I will need to re-attend for the Top-Up procedure after the first procedure.

10. The Top-Up procedure as mentioned above will be organised following the initial procedure and ideally should be carried out approximately 6-8 weeks after the initial procedure. A top-up can only be performed as part of the initial treatment if performed within a maximum of 12 weeks after the initial procedure. I understand that if I do not return for the Top-Up procedure within this timeframe for any reason, I will be charged as per ‘Refresh Top-Up’ prices.

11. I understand that once the pigments are tattooed in the skin, by any method, the colour will fade eventually over time. I accept the fact that even though the pigment will fade over time, the pigment will remain in the skin.

12. I have been informed that sterile disposable tools, needles and consumables will be used on for each individual client and surfaces will be sterilised after each treatment.

13. When a Micro Pigmentation / PMU procedure is completed, it is likely that you will experience some slight swelling and redness of the skin. This will usually subside within few hours.

We insist that the aftercare procedure and advise if followed exactly, to ensure your skin heals safely and for the best retention results.

We strongly advise not to use any other cosmetics on the treated area other that those given at the treatment.

14.  Once I have had a procedure done, I am aware that the true colour will only appear after the skin has healed from 4-6 weeks. (Although this varies and is not guaranteed as explained in (7).

15. I agree to adhere to Post-Treatment Aftercare instructions and advise that I am provided with.

16. I consent to the taking of ‘Before’ and ‘After’ photographs of my procedure(s) and I assign all intellectual property rights (including moral) in the photos to the technician.

17. I confirm that I have asked any questions that I feel I need to ask my Technician, to ensure that I fully understand the different aspects and expectations of the procedure before it is completed.

18. The level of pain that clients feel during treatments differs per person, based on skin maturity, nerve ending, hormonal factors, stress levels. Micro Pigmentation / PMU is most commonly described as a light scratching sensation which is not considered painful, however discomfort should be expected.

19. Cancellations and Rearrangements-

Client must notify us within 48 hours of any scheduled appointment in order to make rearrangements. Failure to notify within the given timeframe, may incur an additional deposit cost of £150 or top-up cost of £150 (under 12 weeks) or refresh top-up price for appointments rearranged after 12 weeks from the initial treatment.

Cancellation of appointments within at least 48 hours, clients will have their deposits returned, if not within the timeframe, deposits are forfeited and non-returnable

20. I agree to abide by all the advice and should I not follow any or some of this advice, I will inform my Technician prior to the treatment.

I have read and understood the above information and have answered the medical questionnaire accurately and have not withheld information which could potentially put me at risk, may affect the healing process or results.