By Tegan - Semi-Permanent Makeup & Beauty Excellence

Client Details

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Last Name *

Phone *

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Date of birth *

Address *

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Client Consent Form

Disclaimer:

I understand and agree to the consent to have a semi permanent make-up treatment performed on me. I agree to hold my practitioner free and harmless from any claims or suits, for damages or any injury or complication that may result from this treatment.

I understand that micropigmentation is a tattoo process and carries with it possible consequences associated with this type of procedure, including but not limited to infection, scabbing, inconsistent colour, spreading of pigments, swelling, redness, discomfort and minor bleeding.

I also understand that the colour, may at first appear darker but will fade up to 50% as scabbing clears and that further treatments may be necessary to achieve the correct balance. A top up appointment between 5/7 weeks is required to perfect the treatment. The top up appointment is to perfect the colour and shape.

I understand that tattooing is permanent but can fade in time.

I confirm that I have completed a skin test and am not aware of any allergic reaction having occurred and I understand this test does not guarantee that I will not have an allergic reaction.

I will adhere to the aftercare instructions. If I do not adhere to the instructions provided there could be loss of colour and shape and in rare cases infection can be caused by touching or picking the treated area. I understand that lip procedures can stimulate any dormant virus such as herpes (cold sores) and that eye procedures can stimulate any dormant eye infections.

Certain medicines can prevent absorption of pigment into the skin and I have not taken aspirin or medication containing aspirin or ibuprofen in the last 2 days.

I UNDERSTAND THAT RESULTS WILL BE BASED ON HEALTH AND QUALITY OF YOUR SKIN AND RESULTS VARY FROM PERSON TO PERSON. If you have a pre-existing skin condition or are on any medication you can still be eligible for the treatment, but you should consider your expectations. Use of any medication, alcohol, smoking or skin conditions can all affect the final result.

I understand that results are unpredictable and depend on a number of factors outside the control of the therapist. Whilst every care will be taken to achieve a satisfactory result it cannot be guaranteed and once the work has been completed no refund is possible.

I fully understand and accept that non-toxic pigments are used during the procedure and that the result achieved may fade over a period of 1-3 years. Even once the colour fades, pigment itself may stay in the skin indefinitely.

I have been informed that the highest standards of hygiene are met and that sterile, disposable needles and pigment containers 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 desired results and that 100% success cannot be guaranteed during the first procedure.

I understand that I may have to return for a repeated procedure. The result of the procedure can be affected by the following: medication, skin characteristics (dry, oily, sun-damaged thick or thin skin type), personal pH balance of your skin, alcohol intake and smoking, post procedure after care.

Upon completion of the procedure there might be swelling and redness of the skin, which will subside within 1-4 days. In some cases, bruising may occur. You may resume normal activities following the procedure, however, using cosmetics, excessive perspiration and exposure to the sun should be limited until the skin has fully healed.

RIGHT TO DISCONTINUE TREATMENT I understand that I have the right to discontinue treatment at any time & I understand payment will still have to be made in full.

PUBLICITY MATERIALS I authorise the taking of clinical photographs and videos. I understand that photographs and video may be taken of me for educational and marketing purposes. I certify that I have read and initiated the above paragraphs and have explained to my understanding the consent and procedure permit. I accept full responsibility for the decision to have this cosmetic semi-permanent pigmentation work done.

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Are you pregnant or breastfeeding at present? *

Yes

No

Are you currently undergoing any medical treatment? *

Yes

No

Are you currently taking any medication? *

Yes

No

Do you suffer from Cold sores? *

Yes

No

Are you allergic to Latex? *

Yes

No

Are you allergic to Lanolin? *

Yes

No

Are you allergic to Vaseline? *

Yes

No

Are you allergic to metals? *

Yes

No

Are you allergic to hair dyes? *

Yes

No

Are you allergic to Lidocaine? *

Yes

No

Are you allergic to Glycerin? *

Yes

No

Do you have sensitivity with cosmetics? *

Yes

No

Do you have an artificial heart? *

Yes

No

Do you have Epilepsy? *

Yes

No

Do you have Alopecia? *

Yes

No

Do you have circulatory problems? *

Yes

No

Do you have Hypertrophic scars? *

Yes

No

Do you have cancer? *

Yes

No

Do you have tumours, growths or cysts? *

Yes

No

Did you undergo chemical/laser peel in the last 2 weeks? *

Yes

No

Have you taken Retin-A in the last 2 weeks? *

Yes

No

Do you suffer from diabetes? *

Yes

No

Do you suffer from high or low blood pressure? *

Yes

No

Do you suffer from Hemophilia? *

Yes

No

Do you suffer from Trichotillomania? *

Yes

No

Do you suffer from Liver problems? *

Yes

No

Do you suffer from Thyroid disturbances? *

Yes

No

Do you suffer from fainting spells or dizziness? *

Yes

No

Do you suffer from hair loss? *

Yes

No

Do you scar easily? *

Yes

No

Do you bruise/bleed easily? *

Yes

No

Have you had botox in the last 3 weeks? *

Yes

No

Do you have any infectious diseases, Hepatitis, HIV or AIDS? *

Yes

No

Do you consent to photos being taken during or after your treatment, which may be used for marketing purposes including social media, website, and printed materials? *

Yes

No

Have you had a patch test/allergy test with negative results at least 48 hours prior to this treatment? *

Yes

No

Are you currently taking any medications? If yes, please list them below.

I agree to terms & conditions provided by By Tegan. By providing my phone number, I agree to receive text messages from the business.

Client Consent form