Eyeliner PMU Consent Form

If you have any medical conditions or are on any medication you should check with your doctor before having this treatment. We will need to ask you some health questions to ensure a safe service and to provide industry specific advice, as this treatment may not be suitable for you if you suffer from certain conditions or are on certain medications.

Where we collect information about your health or medical circumstances, we have a legal obligation to collect this information for health & safety and insurance purposes and only do so with your explicit consent. The privacy and security of your data is very important to us and we will only use health related information for the purposes described on this form and in our Privacy Notice.

I confirm I have eaten in the last 2 hours.

I confirm I am feeling feeling fit and well for my treatment today.

I confirm that I am not under the influence of drugs or alcohol.

I confirm that I am not pregnant or breast feeding.

I confirm I am over the age of eighteen

To my knowledge, I do not have a physical, mental or medical impairment or disability which might affect my wellbeing as a direct or indirect result of my decision to have a PMU.

I have met with my practitioner and have discussed the alternatives, advantages, disadvantages, risks and side-effects of the treatment.

Although I have received a full consultation to decide the style of eyeliner, I understand that the treatment I am about to receive has healing variables, therefore healed results cannot be guaranteed.

I understand that PMU is a minimum of 2 sessions in the process, with colour being implanted slowly and carefully over a period of time in a "layering" process. Eyeliner occasionally needs 3 treatments for the best

results.

I understand my eyeliner will appear much darker when initially implanted but should exfoliate naturally and lighten within 10 days.

I understand that additional work cannot be undertaken for 4-8 weeks in order to allow the skin to fully heal.

I understand that all colours will fade and alter over time. To keep a fresh appearance, a retouch procedure will be required as discussed. Fade is dependent on age, skin type, medication, chosen colour and sun exposure.

I agree that my practitioner will use a treatment plan to keep a log of the chosen pigments, along with my pre- and post-treatment photographs.

Pre- and post-treatment photographs may be used for advertising purposes, unless the client specifically instructs the practitioner not to do so in writing.

I understand that, after each treatment, the treated area may swell or show redness and, in some cases, bruise. My practitioner will recommend how to take care of this.

I understand I may experience some discomfort, however, my practitioner will reassure me throughout and will endeavour to make me feel comfortable, using topical anaesthetics for comfort.

I understand that during an eyeliner procedure there is a risk of a corneal abrasion, burn or irritation to the eyes resulting in discomfort or unusual itching. I must adhere to True Tattoos instruction to keep my eyes closed during treatment, unless instructed otherwise.

I understand that protective eye drops will be placed into the eye to minimise the risk of irritation or corneal abrasion. My practitioner will check my comfort continuously during treatment and if there is any stinging or discomfort in the corneal area then I must inform her immediately so that the eyes can be flushed immediately. Delay of informing my practitioner of any irritation can result in any kind of adverse reaction close to the area.

I understand that if I have had an MRI or CAT scan, I must inform my radiologist that I have had a micropigmentation procedure.

I will be given aftercare instructions and I understand that it is my responsibility to adhere strictly to these instructions, or it could hinder the results and cause adverse reactions post-procedure.

I understand that PMU involves implanting pigment into the skin through minute punctures and that repetitive treatments run the risk of creating scar tissue. I will not touch, rub or pick the treated area during the healing process.

I understand and accept that all PMU treatments carry a risk of infection which may cause scarring.

I understand that - even if a test patch is completed - there is still a risk of allergic reaction on subsequent treatments to any of the products used.

I understand that if my practitioner suspects any kind of adverse reaction to the procedure, or any kind of worrying signs including, but not limited to, excessive client discomfort or anxiety, then she will stop immediately for my safety. This may result in an unfinished procedure but I

understand that my safety is the most important factor when a decision to stop a procedure is made.

I understand that PMU is an artistic treatment where my practitioner use their skills to create a look that she would view as "enhancing" your natural beauty. We will work with you to come to a mutual agreement during the pre-draw process on the desired outcome.

My practitioner will not perform a procedure she is not confident will enhance your natural beauty and will refuse treatment if we cannot reach a mutual agreement beforehand. Due to this agreement before any procedure is undertaken, the business does not offer refunds.

By signing below, I acknowledge that I have received a full consultation where all advantages,

risks and expected outcomes have been discussed in detail.

I understand the pricing structure for the initial session, and for all retouch appointments 4-6 weeks later. If, in the unusual circumstances that a second retouch appointment is needed, this will again be charged. A yearly colour boost is required to keep PMU looking best and this is an additional cost.

I have had the opportunity to ask questions, discuss any concerns and to fully consider the procedure, what it entails and its alternatives before I am treated. I am signing to give full informed consent to the treatment knowing what it entails, the aftercare, maintenance, risks and further treatments needed for the optimum results.

The above questionnaire is accurate and I have disclosed my most recent medical history. Specific advice relating to my chosen procedure has also been discussed.

I fully agree to Eyeliner Permanent Makeup Terms of Treatment.