Consent

1. I hereby authorize The Girly Birds to perform permanent cosmetic enhancements on me. I understand that if any unforeseen circumstances arise during the procedure, I authorize the practitioner to use their professional judgment to take any actions they deem necessary and appropriate.

2. I understand that permanent cosmetic enhancement is a specialized form of tattooing. I acknowledge that the results are considered permanent and can only be removed through laser procedures, which may result in permanent scarring or disfigurement. I accept full responsibility for approving the color, shape, and placement of the enhancement as discussed and agreed upon during my consultation.

3. I understand that permanent cosmetics are permanent and that if I choose to have them removed, it will be at my own expense and leave scars.

4. I understand that a sensitivity test for pigment does not guarantee that I will not have an allergic response. I am aware that an allergic response to pigment is rare and accept all responsibility if allergic response occurs. I am aware that a sensitivity reaction to anesthetics can occur and accept all responsibility of allergic reaction occurs. I fully understand and accept that non-toxic pigments are used during the procedure and that the cosmetic enhancement achieved may fade over the course of 1-3 years. Even though the color has faded, the pigment will stay in the skin indefinitely and may leave a light residue of color. I understand that dyes, inks, and pigments are not approved by the Food and Drug Administration and the health effects are not known. I accept that the highest standards of hygiene are met and that sterile disposable needles are used for each individual client, procedure, and visit.

5. I understand and accept that each procedure is a process requiring multiple applications of pigment to achieve desirable results, and that 100% success cannot be guaranteed. I understand that is why I need to return for a touch-up procedure that is NOT included in the initial price. I understand that the pigment may migrate under the skin, however, this is a rare occurrence, I understand that permanent cosmetic enhancement is an invasive procedure, and the infusion process can be uncomfortable.

6. I understand that the touch-up procedure, if required, will be performed six to eight weeks after the initial procedure. I understand that a touch-up procedure takes place six to eight weeks after the initial application to allow the procedure site to fully heal. I will book the appointment when it is convenient for both parties. I understand that the touch-up is NOT included in the initial service price.

7. I understand that the loss of any eyelashes during the healing of permanent cosmetic eye enhancements will result in new eyelash growth over a four month period and that the eyelash loss is rare and minimal. I understand that in rare cases that corneal abrasion can occur during eyeliner procedures.

8. I am aware that the result of the procedure is determined by the following: medication, skin characteristics-i.e. dry/oily/sun-damaged, natural skin overtones and undertones, alcohol intake, smoking, general stress, a compromised immune system, diet, and post procedure care treatment.

9. I have been advised that upon completion of the procedure there may be swelling and redness of the skin, which will subside within 1-4 days dependent on lifestyle. In some cases, bruising can occur.

10. Aftercare instructions have been explained to me and a written copy has been 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.

11. I understand that Retin A, Renova, Alpha Hydroxy, Glycolic Acids and lash serums must not be used on treated areas. They will alter the color and cause premature exfoliation of the pigment.

12. I understand tanning beds, pools, sun exposure, some skincare products and mediations can affect my permanent makeup.

13. I understand that successful color saturation can NOT be guaranteed due to hidden scar tissue.

14. I acknowledge that the proposed procedure(s) involve inherent risks and have possibilities of complications during and/or following the procedures such as: infection, misplaced pigment, poor color retention, hyper-pigmentation, scarring, bleeding.

15. I agree to follow all pre-procedure and post-procedure instructions as provided and explained to me by the technician. Failure to do so may jeopardize my chance for a successful procedure.

16. I have been quoted the cost of today's appointment and the cost of the touch-up. Touch-ups must be completed within the 8 week time frame from completion of the initial procedure or may be subject to an additional charge.

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). 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 Trisha Bailey and or Jennifer Dean as my technician(s) to perform the permanent makeup procedure for my eyebrows, eyeliner, lip blushing, scar camouflage or stretchmark treatment.