I understand that all semi-permanent procedures carry with them the possibility of complications and consequences including but not limited to fading of skin pigments, risk of infection, scarring eye damage, inconsistent colour and bruising. If I would like the best results from the procedure then I will need to follow after-care instructions and book in for a 4-8 week follow up.

I have been informed that colour may vary as the skin heals. I have advised my provider if I am susceptible to cold sores. I understand that having a lip procedure may inflame cold sores, especially if I suffer from cold sores. I have consulted with a doctor and received treatment prior to any lip procedures if I am susceptible to cold sores. I have received detailed instructions for the aftercare of my treatment and I will strictly adhere to these instructions. I understand that this treatment is for cosmetic purpose only. That no guarantees have been made to me regarding the results, I am responsible for the after care using only the aftercare advice provided, if not I may have risk of infection or fading of pigments if not carried out fully. The general nature of tattooing as well as the specific procedure to be performed has been explained to me. I understand that I cannot donate blood for 6 months after the treatment.

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I understand that the provider of this procedure takes no responsibility for any possible complications and consequences that may result from the procedure, particularly if I neglect to answer these questions properly, if I fail to accurately disclose my medical history or if I fail to take pre-procedure and or aftercare treatment. I will not hold the therapist responsible in the event of any damage and shall not be entitled to take action against him/her at Law or Equity for such treatment. I consent to before and after photographs of this procedure, which is at the therapist's discretion. I consent to the therapist applying the topical anaesthetic products containing Lidocaine, Tetrocaine, Benzocaine, Epinephrine to the treatment areas and reapplying where necessary. I am over the age of 18 years old. I am not pregnant. I have answered truthfully to all above questions on this form. If I experience any changes, reactions or concerns after my treatment I will notify my therapist immediately for further consultation.