Pigment Lightening Consent | Naked Face Spa LLC

REPIGMENTATION & TATTOO REMOVAL / LIGHTENING CONSENT FORM

I_____(Client Name)

had previous work done on my (what area(s))

on approximately (Date)

The work was done by (name of previous technician who performed the undesirable work )

I was not happy with the work that was done. I now want to attempt to have it lightened. I have not been given any guarantees as to how the results of the pigment lightening may be. I understand that several treatments may be needed in order to achieve the desired results, if in fact they can be obtained. I have been told of other options such as laser and I have decided to pass on those methods. I have also been told that permanent scarring, keloid (raised scar), hypo and/or hyperpigmentation (lightening and darkening of the tissue) will be a result of the attempt to lighten the pigment from the desired area. I understand that eye irritation, corneal abrasion/burning, and/or other eye related complications may occur if any accidental contact is made with the eyes, and I take full responsibility for the risks therein.

I agree that I will not hold (name of permanent makeup technician who will attempt to lighten the pigment) or NAKED FACE (name of salon or establishment) or the manufacturer or distributor of the pigment lightener liable for any damage that may occur as a result. I agree that all of the above is true and correct and by my signature I agree to the above.

Signature of Client

Date

Witness thereof:

Date

Thanks for submitting!

REPIGMENTATION & TATTOO REMOVAL / LIGHTENING CONSENT FORM

Naked Face Updates