Permanent Makeup Medical History & Consent Form

There are certain medical conditions that may cause an increased level of risk to the clints health and safety, up to and possibly including death, if a person with those conditions were to undergo a body art procedure. If a client has one of those conditions, they are encouraged to tell the body art operator or apprentice, as that may change or affect the way in which the procedure is done. Also, if a client has one of those conditions, they are encouraged to obtain consent from a physician prior to undergoinga body art procedure. The conditions include:

diabetes, hep a,b or c, history of allergies or adverse reactions to pigments and dyes, metal, or latex or any other skin sensitivities, hiv or aids, hemophilia, history of skin lesions or skin,sensitivities to soaps and disinfectants, history of epilepsy, seizures, narcolepsy or fainting, high blood pressure or heart disease, any contagious disease, serious medical or mental health problems, medications that may affect bleeding or blood clotting, pregnancy, any immune system disorders, mrsa

by affixing my signature below, i hereby give Bronzed and Bladed permission to perform the above mentioned body art procedure

Procedure Explained
Although Permanent Makeup is effective in most cases, no guarantee can be made that a specific client will benefit from the procedure.
This is the process of inserting pigment into the basal layer of the epidermis. It is a form of tattooing, though semi- permanent, it is considered a permanent marking.
All instruments that enter the skin or come in contact with body fluids are disposable and disposed of after use. Cross contamination guidelines are strictly adhered to.
Generally, the results are excellent. However, a perfect result is not a realistic expectation. It is usual and advised to expect a touch up after healing is completed, which is usually 6-8 weeks after first procedure.
Initially the color will appear more vibrant or darker compared to the end result. Usually within 5-7 days the color will fade 30-50%, soften and look more natural. The pigment is semi-permanent and will fade over time. Additional touch ups are likely needed within 1-2 years.
Although numbing cream is used during the procedure, sensitivity and discomfort may still be felt. Skin may be red and/or swollen after the procedure.
During the procedure, despite the staff expertise and all the precautionary measures, injury is possible. Despite the application of the most advanced and top quality pigments, allergic reaction is possible, but rare. The client is informed about this and he/she assumes liability.
During and after the procedure temporary swelling, redness and or itching may occur.
The Pigment is absorbed differently due to differences in the skin quality, thus there is no warranty for the treatment success.
The shape is determined according to the face proportions.
The minimum or maximum duration of Permanent Makeup procedures cannot be determined with certainty nor can the warranty be given on performed treatment.Possible Risks, Hazards, or Complications
Pain: There can be pain even after the topical anesthetic has been used. Anesthetics work better on some people than on others.
nfection: Infection is very unusual. The areas treated must be kept clean, and only freshly cleaned hands should touch the areas. I will have detailed Aftercare instructions for you to follow.
Uneven Pigmentation: This can result from poor healing, infection, bleeding, or many other causes. Your follow-up appointment will likely correct any uneven appearance.
Asymmetry: Every effort will be made to avoid asymmetry, but our faces our not symmetrical so adjustments may be needed during the follow-up session to correct any unevenness.
Excessive Swelling or Bruising: Some people bruise or swell more than others. Ice packs may help reduce the swelling. The swelling or bruising typically disappears in 1-5 days. Some people don't bruise or swell at all. Anesthetics: Topical anesthetics are used to numb the area to be tattooed. Lidocaine, Prilocaine, Benzocaine, Tetracaine, and/or Epinephrine cream and/or liquid are used. If you are allergic to any of these, please inform me now.
MRI: Because pigments used in Permanent Makeup procedures contain inert oxides, a low level magnet may be required if you need to be scanned by an MRI machine. You must inform your MRI Technician of any tattoos or permanent cosmetics.
Allergic Reaction: Although an allergy is unusual, there is always a possibility of an unknown allergy to the pigments and materials used during procedure.
The alternative to these possibilities is to use traditional cosmetic and NOT undergo the Semi-Permanent Eyebrow procedure.
Permanent makeup always leads to skin injury. Therefore, it is important to carefully and gently nurture your skin after the treatment to allow healing without complications. Inadequate care in the healing phase of the skin can lead to poor results for which Bronzed and Bladed and Kristen bechtoldcannot be held liable.
Permanent makeup is an art and not science. Clients result will vary and using make up pencil or brow powder may still be needed.

Deposit Policy
There is a $100 deposit due in order to reserve your appointment time the day of scheduling. The $100 will go towards your procedure fee.
Cancellation Policy:
A 72 hour cancellation notice is required to cancel an appointment.
If you fail to cancel your appointment within the 72 hours, your deposit will be forfeited.
An additional deposit will be required to make a new appointment reservation if you decide to reschedule in the future.
Rescheduling/Late Policy:
To avoid unfair delays to clients, if you are more than 10 minutes late to your appointment it will be necessary to reschedule.
No Show Policy:
Any client that does NOT show for a scheduled appointment, will forfeit their deposit.
An additional deposit will be required to make a new appointment reservation if you decide to reschedule in the future.
***I understand that unforeseen circumstances may arise that could force you to postpone/reschedule your procedure.
Please understand that such changes affect not only your technician, but other clients as well.
If you choose to reschedule your appointment, a minimum 24 hour advance notice is mandatory or the deposit becomes non-refundable.
If you DO NOT reschedule you will lose your deposit and any other future appointments will require another $100 deposit to secure your appointment.

Waivers, Photo, Video Release & Copyrights
As stated above, despite the application of the most advanced and top quality pigments, allergic reaction is possible, but rare. The client is informed about this and he/she assumes liability. I fully understand this above statement.

As part of your treatment, I will be photographing the face or treatment area of your brows and eyes (and in some cases, filming the treatment process). This will allow us to visually monitor your individual before and after results. I would appreciate your willingness to share your outcome with others.
I give my full consent for all photographs/footage captured before, during, and after my treatment by Alicia Berger, Brow Pretty to remain the property of the shop with this consent. I further acknowledge that my participation is voluntary and I will not recieve financial compensation of any type associated with the taking or publication of these images/footage. I, the under signed model, assign you the copyright 

Please note:
*****Only the client will be allowed in the treatment room.*****
NO FAMILY, FRIENDS, MINORS, TODDLERS, OR INFANTS ALLOWED AT THE TIME OF PROCEDURE. No Exceptions. 

I hereby consent to being a client of Kristen Bechtold, Bronzed and Bladed and to receive treatment by her, for the purpose of executing the procedure known as Permanent Makeup.
I agree to waive and release to the fullest extent permitted by law Kristen Bechtold, Bronzed and Bladed from all liability for any and all claims or causes of action that I, my estate, heirs, executors, or assigns may have for personal injury or otherwise, including direct, indirect, and/or consequential damages, whatever the nature, which result or arise from application of my Permanent Makeup application whether caused by the negligence or fault of either Kristen Bechtold, Bronzed and Bladed to . I accept full responsibility for possible complications that may arise or result during or following the Permanent Makeup procedure.
I understand that the Permanent Makeup procedure carries with them the possibility of complications and consequences associated with this type of cosmetic procedure, including but not limited to: infection, allergic reactions, scarring, inconsistent color, and spreading, fanning, or fading of pigments. I also fully understand the possibility of other complications or consequences not related or indicated within this consent form. I understand that if I have an infection, adverse reaction, or allergic reaction to the procedure, I must notify Kristen Bechtold, Bronzed and Bladed and a health care provider, Department of Health, Drugs, and Medical Devices Division 1-888-839-6676.
I have received written Aftercare Instructions on the care of my Permanent Makeup application while it's healing, and I acknowledge that it is possible that the Permanent Makeup application can become infected; particularly if I do not follow the instructions given to me.
I understand the actual color of the pigments may be modified slightly due to the tone and color of my skin. I understand that over time, the colors and the clarity of my Permanent Makeup will fade due to unprotected exposure to the sun and naturally occurring dispersion of pigment under the skin. The application of Permanent Makeup is likely to result in a permanent change to my appearance and can only be removed by laser or surgical means, which can be disfiguring and/or costly and which in all likelihood will not result in the restoration of my skin to it's exact appearance before being tattooed. I fully understand this is an artistic tattoo process that she was taught and learned as such. Therefore it is not a science but a learned art form, purely artistic in it's nature. I request the Permanent Makeup procedure(s) and fully accept the semi or full permanence of the procedure as well as the possible complications and consequences.
I agree that Kristen Bechtold, Bronzed and Bladed has given me the full opportunity to ask any and all questions about the application of my Permanent Makeup and all questions have been answered to my total satisfaction. I acknowledge that I have been given adequate opportunity to read and understand this document, that it was not presented to me at the last minute, and I understand that I am signing a legal contracted agreement, waiving certain rights to recover against Kristen Bechtold, Bronzed and bladed.
I am over the age of 18 and in sound mind, body, and health. I do not have any type of mental impairment that may affect my judgement. I am not under the influence of drugs, alcohol, or any other mood altering prescriptions. I have the Before/Aftercare Instructions and fully understand the information above.
I understand that all sales are final and there will be no refund by any means if not content with the final result. I can confirm that all the information provided by me is correct and truthful.

Bronzed and Bladed 508 HWY 52 Velva, Nd58790 701-500-8536 bronzedbykristen@gmail.com