ACKNOWLEDGEMENT OF THE RISKS OR COMPLICATIONS ASSOCIATED WITH THE PERMANENT COSMETIC TATTOO PROCEDURE Sample Clauses

ACKNOWLEDGEMENT OF THE RISKS OR COMPLICATIONS ASSOCIATED WITH THE PERMANENT COSMETIC TATTOO PROCEDURE. A. The Releasor has been informed by the Releasee of the possible dangers that may occur as a result of having permanent cosmetic tattoo procedures performed. The Releasor acknowledges that those dangers may include eye injury from the permanent cosmetic eyeliner procedure, allergies from pigment used in the procedure(s), fever blisters or cold sores from the permanent lip procedure, swelling, bruising (although rare), temporary minor bleeding, redness or pinkness, and soreness. The Releasor understands and acknowledges that the permanent cosmetic tattoo procedure may permanently alter the appearance of the Releasor’s face, which may or may not be desirable to the Releasor. B. Now, the Releasor having been fully and completely advised of all inhernet risks, dangers, or complications which may arise from a permanent cosmetic tattoo procedure, voluntarily assumes any and all risks, dangers, or complications which may arise from a permanent cosmetic tattoo procedure. To help minimize any risks, the Releasor will answer Yes or No the following conditions in order to describe if the Releasor has any of the following medical conditions: If Yes, Explain: 1. Keloid ❑ Yes ❑ No Location: 2. Diabetes ❑ Yes ❑ No 3. Alcoholic ❑ Yes ❑ No 4. Epilepsy ❑ Yes ❑ No 5. Under 18 Years Old ❑ Yes ❑ No If yes, the client must wait until at least 18 years of age to have permanent makeup, with the exception of areola procedures with a doctor’s note and parental permission 6. Using Accutane ❑ Yes ❑ No 7. Using Retin-A ❑ Yes ❑ No 8. Hemophiliac or other bleeding disorder ❑ Yes ❑ No 9. Pregnant or Nursing ❑ Yes ❑ No 10. Active Skin Disease ❑ Yes ❑ No