This is a PRE SCREENING of the consent form that must be filled before all permanent makeup, paramedical tattooing or tattoo procedures, however this form is not to be filled out until you are at your booked appointment.

It is encouraged to be looked over beforehand, but Your artist will provide this form to sign at your appointment.

HOUSE OF SATURN 

PERMANENT MAKEUP/TATTOOING CONSENT & RELEASE FORM

Name:_______________________ Date of Birth:__________________

 Cell:________________Email:________________________________

Emergency Contact & #: _____________________________________

HEALTH DISCLOSURE

Please check all that apply:

☐ Pregnancy or Breastfeeding.   ☐ Diabetes.    ☐ Heart Condition ☐ Thyroid Condition.  ☐ Seizure Disorder / Epilepsy. ☐ Blood Clotting Disorder ☐ Hepatitis.     ☐ HIV / AIDS.      ☐ Taking Blood Thinner ☐ Skin Condition in Treatment Area.  ☐ Previous Permanent Makeup in Treatment Area ☐ Recent Botox or Filler (within 2 weeks) ☐ History of Cold Sores (for lip procedures)

 ☐ Allergies: ______________________________________________________

☐ Other Medical Condition(s): ________________________________________

☐ None of the Above

CONSENT

• I am 18 years of age or older and can provide valid government-issued identification upon request.

• I am voluntarily receiving a tattoo/permanent makeup procedure.

• I have disclosed all known medical conditions that may affect the procedure or healing process.

• I understand permanent makeup is a multi-step process and an initial touch-up appointment is required to complete the procedure and achieve optimal healed results (or multiple touch-ups depending on the service). (Only applicable for pmu not tattoo) 

• I understand my initial appointment fee does NOT include future touch-up appointments.

• I understand that choosing not to attend a recommended touch-up appointment for pmu may result in incomplete, uneven, lighter, or unfinished healed results.

• I understand healed results vary between individuals and no guarantees have been made regarding retention, colour, shape, or final appearance.

• I agree to follow all aftercare instructions and understand improper aftercare can affect final results.

• I understand that, as with any body modification procedure, tattooing and permanent makeup carries a small risk of infection. I agree to seek appropriate medical attention if complications arise.

• I release and hold harmless House of Saturn, its owners, employees, contractors, and artists from any claims, damages, or liability arising from this procedure, except where prohibited by law.

PHOTO RELEASE (OPTIONAL)

☐ I consent to photographs/videos being used for portfolio, website, and social media purposes.

☐ I do not consent.

Client Signature:_____________________________Date:__________

Artist Signature:_____________________________Date:___________