Answer the questions of the digital beauty waiver and read the terms carefully.

Beauty by Carmenina

Permanent Cosmetics

CONSENT AND RELEASE AGREEMENT FOR PERMANENT COSMETICS

This form is designed to give information needed to make an informed choice of whether or not to undergo a permanent cosmetics application. If you have questions, please don’t hesitate to ask.
Although permanent cosmetic tattooing is affective in most cases, no guarantee can be made that a specific client will benefit from the procedure.

This is the process of inserting pigment into the dermal layer of the skin and is a form of tattooing.
All instruments that enter the skin or come in contact with body fluids are sealed a sterilized before use and disposed of after use. Cross contamination guidelines are stickily adhered to.

Generally, the results are excellent. However, a perfect result is not a realistic expectation. It is usual to expect a touch-up after the healing is completed.
Initially the color will appear much more vibrant or darker compared to the end result. Usually within 57 days the color will fade 10-50%, soften and look more natural. The pigment is permanent but will fade somewhat over time and will likely need to be touched-up through the years.

PHOTOGRAPHY AND VIDEOGRAPHY RELEASE CONSENT

Our insurance company requires “Before” and “After” photos/videos be taken and kept on file. We would like your permission to use these photos/videos for advertising. For example, in portfolios, online and in print adds, etc. Your consent is necessary regarding this.

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POSSIBLE RISKS, HAZARDS OR COMPLICATIONS

Pain: There can be pain even after the topical anesthetic has been used. Anesthetics work better on some people than others.
Infection: Infection is very unusual. The areas treated must be kept clean an only freshly cleaned hands should touch the areas. See “After Care” sheet for instructions on care.
Uneven Pigmentation: This can result from poor healing, infection, bleeding or many other causes. Your follow up appointment will likely correct any uneven appearance.
Asymmetry: Every effort will be made to avoid asymmetry but our faces are not symmetrical so adjustments may be needed during the follow up session to correct any unevenness.
Excessive Swelling or Bruising: Some people bruise and swell more than others. Ice packs may help and the bruising and swelling typically disappears with 1-5 days. Some people don’t bruise or swell at all.
Eye Exposure: There is small risk of eye injury when an eyeliner procedure is performed. To avoid corneal abrasion, Celluvisc, a thick eye drop is used to protect the eye prior to the procedure. Eye drops are used to cleanse and flush the eye after the procedure is complete.
Anesthesia: Topical anesthetics are used to numb the area to be tattooed. Lidocaine, Prilocaine, Benzocaine, Tetracaine and Epinephrine in a cream or gel form are typically used. If you are allergic to any of these please inform me now.
MRI: Because pigments used in permanent cosmetic procedures contain inert oxides, a low level magnet may be required if you need to be scanned by an MRI machine. You must inform your technician of any tattoos or permanent cosmetics.
Fever Blisters: If you are prone to cold sores or fever blisters, (herpes simplex), there is a high probability that you will get them. It is advised that you call your doctor for a prescription antiviral to help prevent this form occurring.
Allergic Reaction: There is a small possibility of an allergic reaction. You may take a 5-7 days patch test to determine this.

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WAIVE Patch Test

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The alternative to these possibilities is to use cosmetics and not undergo the Permanent Cosmetics procedure. Consent and release for procedures performed.

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STATEMENT OF CONSENT AND RECITALS

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Aftercare instructions have been explained to me and a written copy will be given to me to retain in my possession, which I will follow to the best of my ability. If I have questions I will call or email you. *Please click the yellow area and provide your initials here.

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I understand that a certain amount of discomfort is associated with this procedure and that swelling, redness and bruising may occur. *Please click the yellow area and provide your initials here.

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I understand that sun, tanning beds, pools, some skin care products and medications can affect my permanent makeup. *Please click the yellow area and provide your initials here.

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I will tell all skin care professionals or medical personnel about my permanent makeup procedures, especially if I’m schedule for an MRI. *Please click the yellow area and provide your initials here.

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I accept the responsibility for explain to you my desire for specific colors shape, and position for any procedure done today. *Please click the yellow area and provide your initials here.

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I understand that implanted pigment color can slightly change or fade over time due to circumstances beyond your control and I will need to maintain the color with future applications and a touch up session within 60 days. *Please click the yellow area and provide your initials here.

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I acknowledge that the proposed procedure(s) involved risks inherent in the procedure and have possibilities of complications during and/or following the procedures such as: infections, misplaced pigment, poor color retention and hyperpigmentation. *Please click the yellow area and provide your initials here.

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I accept full responsibility for the decision to have this cosmetic tattoo work done. *Please click the yellow area and provide your initials here.

I certify that I have read or have had read to me the contents of this form. I understand the risks and alternatives involved in this procedure(s) and I have had the opportunity to ask questions and all of my questions have been answered. I acknowledge that I have reviewed and approved the material given to me and I authorize Carmenina Mancino (Beauty by Carmenina), as my permanent cosmetics technician to perform on my body the following procedures.

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AFTERCARE

After care is very important for producing a beautiful and lasting result.

Keep the area clean by washing with freshly washed hands and a
mild soap. Do not use a washcloth or sponge to remove soap. Simply splash with water. Do not use cleansing creams, acne cleansers or astringents. Use a mild, natural soap.
Apply the aftercare balm with freshly washed hands or a Q-tip. If the balm is too stiff to use simply warm it up in a glass of warm water or on your finger. Use the balm very sparingly. Too little is better than too much. Blot off excess with a clean tissue. Never touch the procedure area without washing your hands immediately before.
Do not scrub, rub or pick at the epithelial crust that forms. Allow it to flake off by itself. If it is removed before it is ready the pigment underneath it can be pulled out.
Do not use any makeup near the procedure area including mascara for eyeliner procedures for at least 3 days. Purchase new mascara and makeup if possible to avoid contamination or bacterial infection.
Always use a sun block after the procedure area is healed to protect from sun fading.

What’s Normal?

Swelling, itching, scabbing, light bruising and dry tightness. Ice packs are a nice relief for swelling and bruising. Aftercare calm is nice for scabbing and tightness.
Too dark and slightly uneven appearance. After 2-7 days the darkness will fade and once swelling dissipates unevenness usually disappears. If they are too dark or still a bit uneven after 4 weeks then we will make adjustments during the touch up appointment.
Color change or color loss. As the procedure area heals the color will lighten and sometimes seem to disappear. This can all be addressed during the touch up appointment and is why the touch up necessary. The procedure area has to be completely healed before we can address any concerns. This takes at least four weeks.

Needing a touch up months or years later. A touch up may be needed 1 to 5 years after the initial procedure depending on your skin, medications and sun exposure. We recommend a touch up 30 days to 90 days after the first session and every few years to keep them looking fresh and beautiful.

Failure to follow after care instructions may result in infections, pigment loss or discoloration.

I have read, understand and agree to the above instructions.

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CLIENT MEDICAL HISTORY FORM

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Date of Birth: *

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Phone number: *Please enter your phone number.

Email: *Please enter your email.

Do you presently have or previously had any of the following:

Do you have a history of cold sores? *

YES

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Are you pregnant or nursing? *

YES

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Do you wear contact lenses? *

YES

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Do you have glaucoma or any other eye disease, disorder or had any eye trauma? *

YES

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Do you have Cancer or have gone through any Chemotherapy treatments in the past 2 years? *

YES

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Do you have epilepsy, hemophilia or other bleeding disorders? *

YES

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Have you had a vision correction procedure such as Lasik surgery in the last 3 months? *

YES

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Are you prone to eye infections (conjunctivitis/pink eye)? *

YES

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Are you on a blood thinning medication? *

YES

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Do you take aspirin? *

YES

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Do you smoke? *

YES

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Do you drink alcohol? *

YES

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Are you currently on Accutane or have taken it within the last year? *

YES

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Do you suffer from any heart conditions? *

YES

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Are you on any steroids or anti-inflammatory medications? *

YES

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Do you suffer from Hepatitis A, B or C? *

YES

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Do you have diabetes? *

YES

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Do you suffer from a medical or skin condition such as keloids, hypertrophic scarring, psoriasis (at the procedure site) or any open wounds or lesions? *

YES

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Do you bruise easily, swell or bleed easily? *

YES

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Do you use Retin-A, Glycolic Acid, Vitamin C or other exfoliates? *

YES

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Do you have an autoimmune disorder? (i.e. Rheumatoid Arthritis, Vitiligo, Pulmonary Fibrosis) *

YES

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Do you have any pre-existing nerve damage in the area that I will be working on? *

YES

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Do you have tattoos? *

YES

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Are any of the colors in your tattoo(s) sensitive sun or rise up in the sun? *

YES

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Are you currently tanned in the area(s) to be treated? *

YES

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Do you have Botox? *

YES

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Have you had Collagen, Restylane or Juvederm injected into your lips? *

YES

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Have you had fat transferred into your lips? *

YES

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Have you ever had an allergic reaction to a topical antibiotic? *

YES

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Do you have any allergic reactions to latex? *

YES

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Have you had a chemical peel in the past 6 months? *

YES

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Have you ever had an allergic reaction to Lidocaine? *

YES

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Do you spend a lot of time in the sun? *

YES

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Have you had any facial cosmetic surgery? *

YES

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Have you had any laser facial treatments? *

YES

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Do you suffer or have recently suffered from any other medical condition that was not mentioned but you feel like I should know of? *

YES

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I agree that all the above information is true and accurate to the best of my knowledge.

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BEFORE AND AFTER YOUR TREATMENT

Before your treatment

Prior to your permanent cosmetic enhancement think about the look that you wish to achieve. As experts in the field of color analysis and makeovers, we ensure that the correct colors and styles are chosen for you, however you are part of the decision making process.

Permanent cosmetic enhancements normally require multiple application sessions. To achieve the best results, you will be required to return for at least one control procedure four to six weeks after the initial application.

Be prepared for the color intensity to be significantly sharper and darker immediately after the procedure. This will subside and become softer as the skin heals. This process can take up to fourteen days.

-Since delicate skin or sensitive areas may be swollen or red, you are advised not to make social plans on the day of your enhancement. -Please wear your normal make-up to your enhancement appointment. -Do not take aspirin or Ibuprofen 2 days prior to and after your enhancement.

-A sensitivity test will be performed unless waived upon request.
-Do not use Retin-A skincare products close to the enhancement area 2 weeks prior to and after your procedure.
-As with electrolysis the National Blood Service does not accept donations of blood for 1 year after a permanent cosmetic enhancement.

Eyebrow Enhancement

-Waxing treatments should be performed no less than 3 days prior to your enhancement.
-IPL laser hair removal should be performed no less than 2 weeks prior to your enhancement.

-Electrolysis treatments should be performed no less than 5 days prior to your enhancement.
-Eyebrow tinting should not be undertaken for 2 weeks after your enhancement.

After your treatment

The area treated may show redness and swelling and that the color looks dark and intense—this is quite normal.

Additional treatments cannot be undertaken until the area has completely healed. A 4/6 weeks healing time is required before any more work can be undertaken.

In order to let your brows heal well, avoid water on the brow area; make up to the brow area, the gym, sauna or pool for 7 days.

Once the area has healed completely, approximately one week, consider using a waterproof total sunblock when going out in the sun to stop the color fading.

Strong chemicals or glycolic acid/peels of any kind may cause the pigment to lighten. Always telephone and check with your consultant if in any doubt.

Do not pick or pull at the treated area, as it will result in pigment loss. You will go through three healing phases: 1-healing, 2-peeling, and 3- fadeing.

You may notice whiteness or blanching around the area, this is quite normal and will subside within 12 hours. If you find any lymphatic fluid or blood weeping you can gently clean the area with saline, cool boiled water and gauze, blotting gently dry to remove any moisture.

With clean hands and cotton pad apply a fine layer of aftercare balm to the treated area. Repeat this procedure up to 3 times a day if the area feels tight.

After the fine scabbing has sloughed away you will see a different hue to the color implanted.

- Giving Blood- The Red Cross has suggested that you do not give blood for 6 months following treatment.

-MRI Scans- This procedure shows up as an artifact on the scan. Some clients may experience a tingling sensation. Please notify your radiologist.

-Injectable- Dermal fillers and Botox can alter the shape of the eyebrows. The client should be advised that injectable should be carried out after a Micorblading procedure and not prior.

-Laser/Pulsed Light- Laser or pulsed light hair removal or skin rejuvenation treatments can cause color change. It is important to advise the therapist that you have had Microblading procedure, as this cannot be rectified with another Microblading procedure.

-Color Refreshing- To keep your new brows looking at there best, it is recommended that you have a color refresh procedure every 12-18 months.

BEFORE YOUR TREATMENT

-Do not work out the day of the procedure.
-Do not tan or have sunburned face.
-Do not take Aspirin, Niacin, Vitamin E or Ibuprofen 24 hours before procedure.
-No alcohol or caffeine on the day of the procedure.
-No waxing or tinting 3 days before.
-Please note that you will be more sensitive during your menstrual cycle.

AFTER YOUR TREATMENT

-No water, cleansers, creams, makeup or any other products on treated area for 10 days.
-4-5 hours after the procedure clean the area with sterile water and cotton pad, gauze or Q-tip and allow to air dry.
-DO NOT rub, pick or scratch the treated area. Let any scabbing or dry skin naturally exfoliate off. Picking can cause scarring.
-Avoid direct sun exposure or tanning for 3-4 weeks after procedure. -Avoid heavy sweating for the first 10 days.
-NO facials, Botox, chemical treatments and microdermabrasion for 4 weeks.
-Avoid sleeping on your face for the first 10 days.

PLEASE NOTE: EYEBROWS WILL APPEAR DARKER AND BOLDER DUE TO NATURAL SCABBING AND HEALING FOR THE FIRST 10 DAYS. THIS IS VERY COMMON FOR ALL PERMANENT COSMETIC PROCEDURES.

Permanent makeup is NOT recommended for any clients who are or have:

-Pregnant or nursing
-Diabetic

-Undergoing Chemotherapy (consult your doctor) -Viral infections and/or diseases
-A Pacemaker or major heart problems
-Had a organ transplant

-Skin irritations near the treated area (rashes, sunburn, acne, etc.) -Sick (cold, flu, etc.)
-Had Botox in the past 2 months
-Used Accutane in the past year

For any additional questions or concerns please call or message me!

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