General Consent Medical Forms T&C's

I understand that permanent makeup is a form of tattooing where specialized pigments are implanted into the skin using fine needles to create the appearance of makeup.

I understand the nature of the permanent makeup procedure and that the results are permanent but may fade over time. I may require touch-ups to maintain the desired appearance. Regular colour boosts are required to maintain the colour and shape of your enhancement. Colour boosts are not included in the initial treatment cost.

I understand that immediately following the procedure, the enhancement may appear 30 to 50% darker than the final desired result and will gradually lighten over the next 4 to 10 days.

I understand that the true colour will appear approximately one month after each application and may vary depending on factors such as skin tone, skin type, age, and overall skin condition. I recognize that some skin types accept pigment more effectively than others, and therefore, an exact colour or effect can't be guaranteed.

I understand the potential risks of receiving permanent makeup such as infection, allergic reactions, scarring, pigment discoloration, pigment migration, uneven or unpredictable results or dissatisfaction with the results.

I acknowledge that i am fully responsibility for the colour, shape, and placement of the enhancement as agreed upon during my appointment.

I understand and accept cosmetic enhancements will fade over time. While the colour may fade, the pigment will remain in the skin permanently and may leave a subtle residue of colour. All pigments used in cosmetic tattooing are subject to fading, this is a natural and unavoidable process.

I understand that the healing process varies for each individual and that I may experience redness, swelling, colour loss or tenderness in the treated area for several days. Aftercare instructions must be followed to ensure proper healing.

I understand that hyperpigmentation (darkening of the skin), hypopigmentation (loss of skin color), or scarring may occur as a result of my body’s natural reaction to the skin being broken during the procedure. I acknowledge that my body is unique, and my permanent makeup techinitian cannot predict how my skin will react to the treatment. I am also aware that pigment migration beneath the skin is a rare occurrence but can happen. My technician has discussed the potential complications, including the possibility of migration, particularly with eyeliner procedures.

I acknowledge that permanent cosmetics may cause interference during an MRI (Magnetic Resonance Imaging) scan, including the possibility of visual distortions on the imaging results. Iron oxide (metallic salts) present in some pigments and may cause a warming or tingling sensation in the treated area during the scan. I understand that it is my responsibility to inform my doctor about my permanent cosmetic procedure (tattoo) if an MRI is required.

I understand that if I have previously experienced cold sores or herpes, undergoing a lip enhancement procedure may result in a outbreak. I have been advised that preventative medication is available either over the counter or by prescription, this can help prevent or reduce the severity of such outbreaks. I also acknowledge that if I have a history of eye infections or disorders, an eyeliner enhancement procedure could potentially cause these to reoccur. I agree to use the appropriate preventative medication if needed. In rare cases, a corneal abrasion may also occur during eyeliner procedures due to the application of anesthetics for comfort. Saline eye wash will be regularly applied during the treatment to minimize this risk.

I confirm that I have disclosed any pre-existing medical conditions, skin conditions, allergies, pregnancy, or medications.

I understand that despite undergoing a patch test, there remains a risk of an allergic reaction to the pigments, anesthetics, or other materials used during or after the procedure.

I consent to photos and videos being taken before and after the procedure for record-keeping and promotional purposes. I understand my identity will remain confidential unless otherwise specified.

I accept full responsibility for my decision to undergo the permanent makeup procedure and release the technician and the business from any liability for complications, dissatisfaction, or unexpected outcomes.

I certify that I am over 18 years of age.

Please check you have read through this form before booking an appointment.

Health Considerations…

By ticking each box I understand that blood thinners should be avoided leading up to my appointment. I will NOT take...

Anti Inflammatory such as ibuprofen, Naproxen, Aspirin

Alcohol & Drugs

Antibuse

Caffeine

DO NOT discontinue any prescribed medications before consulting your doctor.

Please list any medications taken in the last 6 months and reason for taking them.

Please tick if you have any of the following conditions

Epilepsy in the last 3 years (doctors consent needed)

Keloid or Hypertrophic scars (contraindication)

Tumours, lumps or cysts (doctors consent needed)

Mole or mole removal near tattoo site

Heart conditions, heart murmur, pacemaker (doctors consent needed)

Anemia (doctors consent needed)

Stroke within the last year (doctors consent needed)

Leukemia (doctors consent needed)

Bruise easily with minor injury

Asthma

Diabetes (insulin dependent- contraindication)

Diagnosed with Cancer or currently receiving Chemo/Radiotherapy within the last year (contraindication)

Finished Chemotherapy or Radiotherapy within the last year (doctors consent needed)

Autoimmune Disease (doctors consent needed)

Hepatitis (doctors consent needed)

HIV/AIDS (doctors consent needed)

Eye conditions such as dry eye, stye, glaucoma or cataract (contraindication) applies to eyeliner treatments

None of the above

If you have a medical condition that hasn't been listed, please give a brief description of your condition.

Cold Sores…

This is the herpes simplex virus, which remains dormant in your system. Please tick YES or NO if you have EVER experienced a cold sore. If you have ticked YES you will need to take oral medication starting 2-3 days before your appointment and continuing for 5-7 days after your treatment. This includes your fine-tune session and any future lip colour boost appointments. (Applies to lip treatments)

Bleeding Disorder (doctors consent needed)

Hemophilia

Von Willebrand Disease

Thrombocytopenia

Glanzmann Thrombasthenia

Bernard-Soulier Syndrome

Vitamin K Deficiency

Liver Disease

Disseminated Intravascular Coagulation

Ehlers-Danlos Syndrome

Hereditary Hemorrhagic Telangiectasia

None of the above

Skin Conditions (doctors consent needed if present near/on treatment site)

Psoriasis (contraindication)

Eczema (contraindication)

Dermatitis (contraindication)

Acne (contraindication)

Impetigo (contraindication)

Vitiligo (contraindication if it's changed in the last year)

Cuts or abrasions near treatment site (contraindication)

Use of Accutaine in the last 6 months (contraindication)

None of the above

Thyroid

Under active

Over active

None of the above

Blood Pressure

High (doctors consent needed if not controlled with medication)

Low

None of the above

Known Allergies

Metals

Pigments

Lidocaine (no numbing available)

Glycerine (contraindication)

Latex

Plasters

Antiseptics

Foods

None of the above

Please state any other allergies that haven't been listed (optional)

Skin Care…

2-3 weeks (the longer the better) leading up to your appointment avoid using products with ingredients, such as Retinol, Retinol A, Hyaluronic Acid, Lytic Acid, Vitamin C & E, AHA, Glycolic Acid or Exfoliants. You can find more information about these products on my website lcpermanentmakeup.co.uk under general information.

By ticking these boxes I agree I will NOT receive the following at least 3 months before my appointment

IPL

Laser treatments

Sun beds

Chemical peel

Microneedling

Botox or Fillers (2-3 weeks)

Dermabrasion

If you have had a baby since your last treatment you will need to carry out another patch test before your appointment. Please contact Laura asap on 07428158718 to make her aware that a new patch test will need to be sent out to you.

I acknowledge that I have provided accurate health information and I have read and understood the terms of this consent form. If doctors consent is required and your doctor declines to sign the consent form or if you have ticked a contraindication, unfortunately Laura will be UNABLE to proceed with your treatment.

Item descriptionTo secure an appointment a £50 NON REFUNDABLE booking fee is required via bank transfer. This fee must be paid within 48 hours of booking to confirm your appointment. If payment is not received within 48 hours, the appointment will be cancelled. For online bookings, deposit payment details will be provided upon booking.

*The booking fee is non-refundable, so it’s important to thoroughly check the medical forms to ensure there are no contraindications before submitting your payment.

*The booking fee can only be transferred to a rescheduled appointment if a minimum of 48 hours notice is given during office hours (Monday to Friday, 9:30 AM – 6:00 PM).

*Failure to provide at least 48 hours notice during office hours (Monday to Friday, 9:30 AM – 6:00 PM) for cancellations, or failure to complete all required forms and follow pre-appointment instructions, may result in Laura being unable to carry out the treatment on the day. In such cases, the treatment will need to be rescheduled, and a fee of 75% of the treatment cost will be applied to cover losses.

*Free fine-tune sessions must be taken within three months of the initial appointment. If you do not attend both sessions or fail to follow the provided pre & post treatment and aftercare instructions, you take full responsibility for the final result. Cancellations of fine-tune sessions with less than 48 hours notice will result in a £65 additional top up fee, which includes a £50 booking fee to confirm the new appointment.

*Additional touch-up sessions may be required at a cost of £65. As individual colour retention can vary, perfect results cannot be guaranteed. Healed results will vary due to factors such as skin type, skin condition, lifestyle, environmental influences, medical conditions and any medications you may be taking. To maintain your desired look, you will need to schedule an annual colour boost. Its recommended to scheduled your appointment within 12-18 months of your last treatment. Any extra colour applications will be charged at £65 and must be completed within three months of your last appointment.

*As permanent makeup is a cosmetic procedure, refunds are not offered if you are dissatisfied with the results. However, adjustments or touch-up sessions may be provided at the discretion of the artist, depending on the situation and within the appropriate time frame.

*If you have disclosed a medical condition or medications that require a doctor’s consent, and your doctor declines to sign the consent form, Laura will unfortunately be unable to proceed with your treatment. Doctor’s consent is a requirement for insurance purposes, and the signed consent form must be submitted to Laura before booking an appointment. If you are unsure whether doctor’s consent is needed, please contact Laura at 07428158718 or lc.permanentmakeup.tattoo@gmail.com.

*As a self-employed professional, I reserve the right to refuse services to clients for health, safety, or professional reasons. Treatments may not be suitable for clients with certain medical conditions, allergies, or skin issues, and in such cases, services will be declined to ensure compliance with insurance requirements and to prioritise the well-being of the client. Additionally, if a treatment request falls outside of my expertise or if a client's expectations are deemed unrealistic, I have the right to refuse the service. This policy ensures that all treatments are performed safely, effectively, and to the highest professional standards.

*I have read and understood the terms and conditions and accept any potential risks and responsibilities associated with the treatment. I acknowledge that results may vary based on individual factors, and touch-ups may be required at an additional cost.

Health Considerations…

Bleeding Disorder (doctors consent needed/contraindication)

Hemophilia

Von Willebrand Disease

Thrombocytopenia

Glanzmann Thrombasthenia

Bernard-Soulier Syndrome

Vitamin K Deficiency

Liver Disease

Disseminated Intravascular Coagulation

Ehlers-Danlos Syndrome

Hereditary Hemorrhagic Telangiectasia

None of the above

Skin Conditions (contraindication if present on tattoo site)

Psoriasis

Eczema

Dermatitis

Acne

Impetigo

Vitiligo

None of the above

Thyroid

Under active

Over active

None of the above

Blood Pressure

High

Low

None of the above

I have disclosed any medical conditions or medications that may affect the tattooing process and healing.

If you have a medical condition that hasn't been listed please give a brief description of your condition...

Please list any medications taken in the last 6 months and reason for taking them.

Allergic Reactions

Known Allergies

Metals

Inks/Pigments

Glycerine

Latex

Antiseptics

Foods

None of the above

Please list any known allergies...

I understand that some people may have an allergic reaction to tattoo pigments/inks. I have made Laura aware of any known allergies before my appointment.

I understand the potential risk of infection, pigment migration, scarring, uneven or unpredictable result.

Age Verification…

I am over 18 years of age

Release of Liability…

I release Laura Clark of LC Permanent Makeup & Fine Line Tattoos from any liability for complications, infections, allergic reactions or dissatisfaction that may arise from the tattooing procedure.

I acknowledge that touch-ups may be necessary, and agree to follow up as advised

Photos and Videos…

I understand that photos and videos will be taken for insurance purposes purposes

I give permission for photos and videos to be taken for portfolios, advertising and posting social media platforms.

As tattooing is a cosmetic procedure, refunds are not offered if you are dissatisfied with the results. However, adjustments or touch-up sessions may be provided at the discretion of the artist, depending on the situation and within the appropriate time frame.

I acknowledge that I have provided accurate health information, I have read and understood the terms of this consent form and agree to proceed with the tattoo.