PMU Intake Form

I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that itsupersedes any previous verbal or written disclosures. I understand that withholding information or providingmisinformation may result in contraindications and/or irritation to the skin from treatments received. The treatments Ireceive here are voluntary and I release this skin care professional from liability and assume full responsibility thereof.*

I hereby consent to and authorize my Cosmetic Professional to perform the requested treatment procedure listed in this booking.*

I certify that I have read and fully understand the Informed Consent for PMU treatments, that I have had sufficient opportunity fordiscussion and to ask questions, and that I hereby consent to the requested treatment procedure listed in this booking.*

I hereby give my informed consent to receive the patch test for permanent makeup, and I waive any claims orliability against the artist for any adverse reactions or injuries that may result from the patch test.*

I hereby grant permission to the rights of my image, likeness and sound of my voice as recorded on audio or videotape without payment or any other consideration. I understand that my image may be edited, copied, exhibited,published or distributed and waive the right to inspect or approve the finished product wherein my likenessappears.