Brow Pigment Removal Consent Form

Full Name *

First

Last

NRIC ( Last 4 digits )

Contact number

Consent & Release Agreement for Brow Pigment Removal

I would like the technician to attempt to completely/partially remove my permanent makeup/tattoo. I understand that several treatments may be needed in order to attempt to achieve my desired results. I have not been given any guarantees as to the removal results.

DECLARATION

I Hereby certify that i am above 21 years of age to have this service performed on me and if i am below 21 years , i hereby declare that i have already seeked parental consent and approval
I hereby declare that I understand that the unwanted permanent makeup/tattoo may not be successfully removed and permanent scarring may result in an attempt to remove the permanent makeup/tattoo as well as hypertrophy and hypo-pigmentation or other damage to the skin which may be permanent.
i hereby declare that i am not allergic to Anesthesia: Topical anesthetics are used to numb the area to be tattooed. Lidocaine, Prilocaine, Benzocaine, Tetracaine and Epinephrine in a cream or gel form are typically used.
I understand that removal procedure is complex, and therefore will not hold responsible the technician for a failure to remove partially or totally.
Furthermore, I will not hold the lash chapter salon or the business of the technician, the distributor and manufacturer of the removal products used in this attempted removal, liable for any damages that may occur to my face or body.
I agree to be taken “before and after” photographs of each procedure, and to comply with any regulations and instructions given to me by the technician.
i hereby declare i am not prone to keloid scarring
I have been duly informed of the nature, risks, possible complications and consequences as listed above. I further understand that the above listed technician is not medical doctor and have neither asked nor received any guarantees or promises as to the results obtained.
I hereby declare i do not test positive for HIV or Hepatitus Virus
I hereby declare that i am not pregnant / breastfeeding
i hereby declare that i am aware there is NO GUARANTEE for the outcome of my procedure.
i hereby declare that i do NOT have any of the medical conditions that were mentioned in the above indemnity form.
I am aware that the treatment with the needles and lactic acid used can cause skin irritation and minor inflammation of the skin which usually disappears within 24-36 hours.
I Hereby certify that i am above 21 years of age to have this service performed on me and if i am below 21 years , i hereby declare that i have already seeked parental consent and approval

What to Expect

What to Expect

The skin might feel warm and tingling sensation may occur after numbing effect is worn off . A scab will form over your treated area and peel off by itself . Please adhere strictly to the aftercare instructions to ensure the best outcome for your procedure and to ensure no skin infection. A pink skin will revealed under the fallen scab and this is normal , it will continue to heal and slowly the skin will slowly mature to the normal skin tone.

Aftercare

You must keep the area dry for 7 days. You can wrap the area with saran wrap before shower to avoid getting it wet.
You must avoid sun contact, swimming pool, sauna, jacuzzi and sea water for the first 10 days.
You must apply sunscreen cream on the treated area that contains zinc.
After about 4 days a scab will form, you cannot touch or peel or scratch the scab. After 10-14 days, it will fall with the pigment that was lift. Once the scab falls the skin underneath is healing. At that point, you can apply the aftercare cream your technician gave you.
If the area itches after the treatment you can gently clean the area , then apply a thin layer of manuka honey to ease the skin
If you need another removal sessions you can have it done after 4-6 weeks.
In case you want to have a new permanent makeup done you can do it after 6-8 weeks after the removal.

IMPORTANT - PLEASE ACKNOWLEDGE *

I acknowledge it is not reasonably possible for my technician to determine whether I might have an ALLERGIC reaction to the pigments, anesthetic or ointment used in this process. I agree to forego a patch test and accept the risk that such reaction is possible. *

IMPORTANT - PLEASE ACKNOWLEDGE *

i undertake the above mentioned and will proceed with the said treatment

Subscribe to our newsletter to receive promotional deals !