Repigment Release Form | Naked Face Spa LLC

RE-PIGMENTATION & LIGHTENING RELEASE FORM

I _____________

residing at

had previous permanent makeup done on my (Select all that apply)

Eyes

Eyebrows

Lips

Body

by (name of previous permanent makeup artist)

on approximately (date)

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 have been informed that there is a possibility
that when needles enter into previous tattooed work, an allergic reaction can be triggered which
can result in oozing, redness, itching and may have to be excised or lasered in order to calm
down the allergy. Knowing this I still volunteer to have permanent makeup applied over
previously done work and

I agree to hold the professional __________ and her employees, landlord, SofTap Inc,and its employees, harmless from any liability or harm that may arise form this re-application of pigment.

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.

I agree that the above is true.

Your Signature

Date

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RE-PIGMENTATION & LIGHTENING RELEASE FORM

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