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Cosmetic Tattoo Consent Form

Let us do this part

Today's Date:

Tue Apr 29 2025 03:48

Practitioner:*

Artist signature:*

Cosmetic Tattoo Consent Form

Please read and answer

I am not pregnant or nursing, and I will not arrive to my appointment under the influence of drugs or alcohol.

The nature and method of the proposed cosmetic tattoo procedure(s) has been explained to me by a qualified technician at Lokahi Studios, including the usual inherent risks during the procedure process and the possibility of complications during and following the procedure(s).

I understand that there is a certain amount of discomfort or pain associated with the procedure(s) and that other adverse side effects may include minor and temporary bleeding, bruising, swelling, and/or redness or other discolorations. Fading and loss of pigment may occur. Due to swelling, unevenness may occur in the design. I acknowledge that tattoos are permanent and tattoo removal is a surgical procedure which may cause scarring and/or disfigurement.

I acknowledge that complications as a result of cosmetic tattoo procedure may include infection, particularly in the event of my post-procedural instructions not being followed.

I acknowledge that secondary infection in the area of procedure may occur, however, adherence to the after care instructions recommended to me by my technician at Lokahi Studios will help minimize the occurrence.

I do not have medical or skin conditions such as, but not limited to acne, scarring (keloids), eczema, psoriasis, freckles, moles, or sunburn in the area to be tattooed that may interfere with said tattoo. I do not have an infection or visible rash anywhere on my body.

I acknowledge that it is not reasonably possible for my technician to determine wether I might have an allergic reaction to the pigments or processes used in my tattoo, and I agree to accept the risk and understand that such reaction is possible.

It has been explained to me, immediately after the procedure(s) is completed, the color will appear darker and bolder. It had also been explained to me that within a short amount of time (usually 5 - 7 days) during the healing process, the color will lighten/soften and the design/procedure will heal softer than it looked the day it was performed. (Please do not pick any scabs and be aware pigment can stain clothing and sheets.)

I acknowledge that hyper-pigmentation (darkening of the skin) or hypo-pigmentation (absence of color in the skin), or scarring is a possibility as a result of my body's reaction to the skin being broken during the procedure. I realize that my body is unique and that the technician can not predict how my body will react as a result of this procedure(s).

I acknowledge that the procedure(s) will result in a permanent change to my appearance and that no representations have been have been made to me as to the ability to later change or remove the results.

I understand that future laser treatments, plastic surgery, implants, injections, and other skin altering procedures may alter and degrade my cosmetic tattoo procedure(s). I further understand that such changes are NOT the responsibility of the technician, and such changes in my appearance may NOT be correctable through through further cosmetic tattoo procedures.

I understand that tattoos may cause MRI (magnetic response imaging) artifacts and that there may be a warming and/or tingling sensation in the tattooed area during the MRI due to the iron oxidize properties of some pigments. It is understood that I should advise my physician that I have permanent cosmetics in the event an MRI procedure is prescribed.

I authorize the technician to obtain pre-procedural and post-procedural pictures, and give her permission to use such pictures for publication and/or teaching purposes as they choose.

I acknowledge the instructions advising me of the proper care of my procedure(s) and recommended healing agent by the technician. I understand the absolute necessity for following these instructions.

I understand that cosmetic tattooing is an art and not an exact science. I acknowledge that no guarantees have been made to me as to the result of this procedure. Some skin types will not accept or heal pigment in a consistent manner. My skin and how I take care of my cosmetic tattoo(s) will determine my result. I realize that my body and skin are unique and that the technician can not in any way predict how your skin may react to the procedure or how it may or may not accept color. A touch up is recommended and encouraged. I also realize that the technician can not predict how many visits it will take to complete my procedure.

I accept full responsibility for determining the color, shape, and position of the pigments that will be applied. I understand that the actual healed color of the pigment applied will be modified slightly due to my own skin's undertones.

This contract is to remain in effect from the date submitted by the client and it's contents are to still apply whenever work is being performed on myself by the technician. It is my responsibility to inform the technician if any changes have occurred in my medical history.

I have read and understand the contents of each paragraph above. I have received no unrealistic warranties or guarantees with respect to the benefits to be realized from, or consequences of the aforementioned procedure(s)

I acknowledge that by submitting this consent form, have been given the full opportunity to ask any and all questions about cosmetic tattoo procedure(s), it's process, and the risks involved from the technician. The decision to have cosmetic tattooing procedure(s) performed is my own and I understand and accept all risks involved, therefore releasing my technician of any and all legal liability. In consideration of my procedure, I hereby release and forever discharge my technician both personally and under the business name of Lokahi Skin & Body Services from all claims, demands, actions and causes of actions arising out of said treatment procedures which I, my heirs, my executors, administrators, or assigns may have stemming from my decision to have either a permanent makeup procedure or areola/nipple procedure. I agree that this waiver also pertains to and is designed to protect any and all establishments where my technician does business. My technician is trained, experienced, and a skilled artist who makes no claims to be anything more. Permanent makeup/cosmetic tattooing is not a medical procedure, but an art form. Any and all fees are to be paid prior to or on the day of the procedure and are non refundable.

If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.

Client Information

I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this agreement.

Name:*

Address:

Postcode:

Date of birth:*

If you are under 18 your parent/guardian will be required

Phone #:*

Email:*

Signature:*

Sign above or type signature:

Photo ID*

Please take photo(s) of your government issued photo IDs and related paperwork.