PMU Consent Form | Laser Brow Edit

First name

Last name

Email

Birthday

Day

Month

Year

Type of PMU

Microblading

Lip Blush

Please tick any conditions that apply to you

Pregnant or Breastfeeding

Diabetic

Haemophilia or other bleeding disorders

Hepatitis or HIV

Autoimmune Disease

Heart Condition/Pace Maker

Prone to Keloid Scarring

Skin disorders eg Eczema, Psoriasis or Dermatitis

Epilepsy or Seizures

Allergies to anaesthetics, pigment, latex or other substances

Currently taking blood thinners or acne medication

Recent cosmetic surgery or facial treatments i.e lip filler

If yes to any of the above, please explain below

Have you had PMU before, if yes what areas have been treated?

I understand that permanent makeup is a form of cosmetic tattooing and carries associated risks.

I confirm that I am not pregnant or breastfeeding at the time of the procedure.

I understand that the results of the procedure may vary depending on my skin type, lifestyle, and aftercare.

I have disclosed all medical conditions that may affect the procedure.

I understand that a healing period is required and that touch-ups may be necessary.

I understand that despite the use of sterile equipment and pigments, there is a risk of infection.

I agree to follow all pre- and post-procedure instructions provided to me.

Declaration : by signing this consent form. I declare that the information and statements given on this form are true and complete to the best of my knowledge. I am aware that any false statements may affect my treatment outcomes and after care.

I hereby release and hold harmless the technician, theclinic, and its employees from any and all claims, damages, or legal actions arising from or connected to the procedure and any possible complications. I understand this is a voluntary procedure and I have been fully informed of the process and potential outcomes.

Full Name

Date of Signature

Day

Month

Year

Signature

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Permanent Makeup Consent

Please fill this out prior to your treatment.