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Advised Consent form for Permanent Cosmetic/Medical

Permanent Cosmetic Procedure

PLEASE READ THE BELOW INFORMATION: 

I hereby authorise Laura Batchelder ​ to perform upon myself the following procedure(s):

- Lip blush

 

If any unforeseen condition arises in the course of this procedure(s), calling in her judgement in addition to, or different from those now contemplated, I further request and authorise him/her to do whatever she deems advisable and necessary in the circumstances.

 

I fully understand, as with all such procedures that this is not a science but rather an art. Depending on the procedure(s) selected, I accept responsibility for determining the colour, shape and position of eyebrows, eyeliner, lip-liner/lip shading, beauty mark, tattoo or other as agreed during the course of my consultation. 

 

It is understood that a sensitivity test is available at least 24 hours prior to procedure for pigments and tropical anaesthetics. The purpose of the test is to detect allergic or other reaction. I understand that if I do not wait 24 hours after the skin test, for treatment that it is at my own risk if any allergy occurs.

 

I fully understand and accept that non-toxic pigments are used during the procedure(s) and that the cosmetic enhancement achieved may fade in between one to three years. Even though the colour has faded the pigment will stay in the skin indefinitely.

 

I have been Informed that the highest standard of hygiene is met, and the sterile disposable needles, and pigments containers are used for each individual client, procedure and visit.

 

I understand and accept that each procedure is a process requiring multiple applications of pigment to achieve desirable results, and that 100% success cannot be guaranteed. I understand that this is why I need to return for a retouch procedure.

 

I understand that a retouch procedure will be performed one to three months after the initial procedure. I understand that after a three month period, I will be charged an additional fee for any further work. I will book the appointment when it is convenient for both parties.

 

The result of the procedure is determined by the following.

 

  1. Medication

  2. Skin Characteristics (dry, oily, sun damaged and thickness)

  3. Natural skin undertones (blending with chosen pigment)

  4. Personal pH balance of skin, which changes from visit to visit

  5. Alcohol intake or smoking 

  6. Post-operative care treatment

 

Upon completion of the procedure there may be swelling and redness of the skin, which will subside in between one to four days. In some cases bruising can occur. Clients may resume normal activities immediately following the procedure, however, using cosmetics, excessive perspiration and exposure to the sun on the affected area should be limited. See specific post- procedure instructions for details. Clients can however, be assured that the procedure, even after one treatment, appears acceptable and that they can appear in public without additional makeup on the affected area.

 

I have been advised that the true colour will be seen in one month after the procedure, and that the pigment may vary in colour according to skin tones, skin type, age and skin conditions. I understand that some skins except pigment more readily than others and no guarantee to an exact effect or colour can be given.

 

I am aware that the lip procedures may stimulate any dormant virus such as herpes (cold sores). I am informed that eye procedures may stimulate dormant eye disorders or eye infections, and that some medication can prevent absorption of the pigment.

 

To my knowledge I do not have any physical, mental, or medical impairment or disability that might affect my well-being as a direct or indirect result of my decision to have the procedure done at this time. I am at least 18 years old. I do not have a heart condition. I do not have epilepsy. I have not had hepatitis within the last year. I am not haemophiliac. I do not have HIV. I am not under the influence of drugs or alcohol.

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