Please read and sign this consent form prior to your procedure. Please review the following information, which refers to your desire or approval to get permanent
makeup procedures done on yourself. If you wish to have a permanent makeup procedure done, you
must complete the attached Medical History forms, and all of the Disclosure and Consent portions of
Please read the statements below placing your initials before each one to indicate that you understand completely:
The Client has been given a copy of this Agreement prior to the permanent makeup procedures
being performed, and has been given the opportunity to attain reasonable understanding of this
Agreement, including the opportunity to ask questions, either by written, verbal or manual
communication prior to the signing of this document.
As a Client, you have a responsibility to inform the Technician working on you, of all possible
concerns. Please read the following and initial before each statement.
I have read and fully understand the questions, terms, and disclosure conditions of Consent Form,
and that this consent form was completed by me, and that all entries and information in it, are true
and complete to the best of my knowledge.