Consent Tattoo Removal

First Name

Last Name

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Address 1

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Consent/ Release

Name

Procedure Date

I was not happy with the work that was done and now I want to attempt to have it lightened. I have not been given any guarantees on the results of the pigment lightening or tattoo removal and understand that several treatments may be needed to achieve my desired results. I have been told that permanent scarring, keloid, hypo and/ or hyperpigmentation (lightening/darkening of the tissue) could be a result of the attempt to lighten pigment from the desired area.

I am fully aware of all things mentioned above and still volunteer to have permanent makeup applied over previously done work. I agree to hold the professional tattoo specialist and Naked Face harmless from any liability or harm that may arise from the reapplication of pigment/ pigment lightening and or removal.

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Date

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Consent Tattoo Removal

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