Consent Form - Emily Wilson Cosmetics

Full Name
Tattooists Name
Photographs for Marketing
Do you give permission for images of your brows to be used for social media content
- I consent to my photos being used for marketing
- I consent to my photos being used for marketing but only of my eyes and brows, not my face
- I do NOT consent to my photos being used for marketing

I {Full Name:4} have had a consultation where I have been advised of the benefits and potential side effects of my brow cosmetic tattoo treatment. I consent to undergoing the procedure and authorize {Tattooists Name:5} (cosmetic tattooist) to act in any way necessary in the circumstances.

I agree that this procedure is being performed for cosmetic reasons only and no guarantee of any nature can be made as to the exact result of the procedure.

I accept that while every precaution has been taken to prevent complications and that wile complications from this procedure are rare, they can and sometimes do occur.

I have read and understand the information on the Consultation form and all my questions have been satisfactorily answered.

The fee for service has been explained to me and it is satisfactory. I understand that there will be a separate service fee for any modification or pigment colour or shape once my initial and touch up session are completed, and there is a no refund policy for service provided.

I understand that the actual colour of the pigment may be modified slightly due to the tone and colour of my skin. I request the Cosmetic Tattooing procedure, appreciating and accepting the permanency of the procedure whether it is for some months or years as well as the possible complications and consequences of the said procedure .

Photographs will being taken as part of my client record and remain confidential.

{Photographs for Marketing:12}

I acknowledge that I have been advised that I cannot donate blood to the blood bank for the following 12 months from today due to this cosmetic tattooing procedure.

I agree that I have a duty to disclose to the Cosmetic Tattooist every matter that I know or could reasonably be expected to know which is relevant to their decision to accept me as a client for a cosmetic tattooing procedure.

I have not been advised of any matter verbally that is not included on the consent form and its attachments.

DO NOT SIGN THIS FORM UNTIL YOU HAVE READ AND UNDERSTAND THE ENTIRE CONTENTS OF THIS PAGE AND ALL YOUR QUESTIONS HAVE BEEN SATISFACTORILY ANSWERED.
Signature*

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10% off your next order

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