Eyeliner Embroidery Consent Form

Full Name *

First

Last

NRIC ( Last 4 digits )

Contact Number

Consent & Release Agreement for Permanent Cosmetic

This form provides information to assist in making an informed decision of whether or not to undergo a permanent cosmetics application. If you have questions, please don‘t hesitate to ask. Although permanent cosmetic tattooing is effective in most cases, no guarantee can be made that a specific client will benefit from the procedure. This is the process of depositing pigment into the top dermal layer of the skin and is a form of tattooing. All instruments that enter the skin or come in contact with body fluids are sealed and sterilized before use and disposed of after use. Cross contamination guidelines are strictly adhered to.

DECLARATION

I hereby declare that I have been informed, in detail about the eyeliner embroidery method and procedure which will be performed. I was informed that needles are used for the treatment to inject colour pigments into the upper layers of the skin.
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 occassionally some individuals may or may not experience swelling or redness for 2 or 3 days . 1 in 25 people may even experience a light bruising which will dissapear quickly
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 herby declare that i am not diabetic
i hereby declare that i am not on Accutane or prescription acne treatment
i hereby declare i am not prone to keloid scarring
i hereby declare that i am not allergic to Iodine
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 have had no Botox treatment for the past 28 days
i hereby declare that i have has no filler injections for the past 3 months
I hereby declare that i am not under treatment for Cancer / Radiation / Chemotheraphy
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 it is not possible to predict how durable and intensive the colour will be and that durability and colour intensity depend on age, skin type and environmental conditions of the treated person.
I am aware that the color retention / durability may varies on different skin type and some skin type may not absorb color well and may require more sessions to achieve the desired outcome.
I am aware that the treatment with the pigmenting needles can cause skin irritation and minor inflammation of the skin which usually disappears within 24-36 hours.
I hereby declare that I am under FULL UNDERSTANDING that the procedure is a Tattoo and a touch-up Session can only be done after 6 to 8 weeks but within 3 months .
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

Generally, the results are excellent. However, a perfect result is not a realistic expectation after an initial application. It is usual to expect a touch-up after the healing is completed ( 6 to 8 weeks ). We recommend 2 sessions to achieve optimal desired results. However in certain cases a third session may be needed with its corresponding fee. Initially the color will appear much more vibrant or darker compared to the end result. Usually within 2 weeks your eyeliner color will lighten 40-50%, soften and look more natural. The pigment will fade somewhat over time and will likely need to be touched-up through the years.

Aftercare

Refrain from touching the treated area.
Avoid IPL / Laser Treatment during healing period
Refrain soaps , cleanser, cream or make up on the treated area for 3 days
Avoid Facial treatment / Sauna / Swimming / Brow tinting or Tweezing or Waxing etc.
• Apply the aftercare ointment with a Q-tip. Use the ointment very sparingly. Never touch the procedure area without washing your hands immediately
• Do not scrub, rub or pick at the epithelial crust that forms. Allow it to flake off by itself. If it is removed before it is ready the pigment underneath it can be pulled out.
• If you have any signs and symptoms of infections we advise for you to seek medical care.

IMPORTANT - PLEASE ACKNOWLEDGE *

I understand that successful color saturation can NOT be guaranteed. I acknowledge that the proposed procedure(s) involve risks inherent in the procedure and have possibilities of complications during and/or following the procedures such as: infection, poor color retention and hyper-pigmentation. *

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 *

All touchup sessions must be completed 12 weeks from initial session. Failure to make this appointment will incur its corresponding fee or forfeited touchup session. Touch up can only be done after 6 to 8 weeks

IMPORTANT - PLEASE ACKNOWLEDGE *

i understand that the therapist will recommend and draw the ideal eyeliner shape, however i am free to change the shape as i desire and understand the shape will be final and cannot be changed after the procedure . As the shape of the eyeliner is very subjective to individual , The final shape decision / approval will be myself and not decided by my therapist . In the event if i am unable to decide the shape , TLC will not proceed with the session.

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