Name *

First Name

Last Name

Phone *

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Permanent Makeup Treatment *

I am aware that it is not possible to predict how durable and intense the brow color will be and that durability and color intensity depend on age, skin type and environment conditions of the treated person.  I was also informed that needles are used for the treatment to insert pigment into the top layer of the skin.  I am aware that the treatment with the pigmenting needles can cause skin irritation and minor inflammation of the skin which usually disappears within 24-36 hours.  I have been informed that the pigments will appear darker within the first few days immediately following the procedure and it will be essential to undergo following touch up treatments as needed.  I have been informed that a section of the skin may be anesthetized or numbed with a surface anesthetic and additional numbing will be applied throughout the procedure.  I have been informed that different medications affect individuals differently and side effects may or may not occur. It is very subjective based on each individual.  Common side effects of anesthetics may include: allergic reaction, light headedness, drowsiness, dizziness, vomiting, numbness of the tongue and a slower heartbeat. 

Yes

Post Treatment *

I understand that during the first 7 days after treatment, I should not: expose the treated area to UV rays, tanning beds, use a sauna or swimming pool, use makeup around my brows and will not pick off flaking or scabbing area

Yes

Furthermore I declare: *

I am not diabetic I have not tested positive for the HIV or Hepatitis Viruses I am not hemophiliac I have not had botox treatments for the past 3 weeks I am not allergic to Red Lake #5 I have not had filler injectables for the past 3 weeks I am not pregnant I am not currently breastfeeding I have informed the technician/student of any medication I am currently taking, which may affect blood coagulation during the procedure * I understand a preliminary drawing will be performed and the result will be presented to me before the procedure begins * I hereby declare that I am not intoxicated 

The above is all true

*

I hereby declare that I am over the age of 18 years 

Yes

No

I give consent to have PMU Brows performed and assume full responsibility for the outcome. I do not and will not hold the technician, Attajaan Ramji, responsible or liable should the result not be as discussed or as I had imagined.

Yes

*

I understand that this agreement will remain in effect for this procedure and all future procedures conducted by the certified technician

Yes

I understand that this consent is legal and binding *

Yes

Photo & Media Consent *

I give permission for my technician/therapist to take photographs and video recordings, before, during, and/or after my procedure. I give permission for my photos to be used on the company social media channels, website and used for any other marketing purpose. I further understand that there will be no financial remuneration for this.

Yes

No thank you

Signature *

First Name

Last Name