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Waiver & Consent

This form is strictly for existing clients of Empress Aesthetics that have a scheduled appointment.

By filling out this form, I acknowledge that I have been advised of the following facts & matters.

  • The method of this procedure of semi-permanent makeup has been explained to me & I am aware of the complications that may arise during and following its performance.

  • I understand that along with minor discomfort or pain, other possible side effects may include; minor & temporary bleeding, bruising, redness or other discoloration and/or swelling. Fever blisters may occur on the lips following lip procedures in individuals prone to the problem. Fading or loss of pigment may occur. Secondary infection in the area of the procedure is rare if properly cared for, but still may occasionally occur.

  • I have informed my practitioner of any known allergies & acknowledge that it is not always reasonably possible to determine in advance whether I might have an allergic reaction to any pigments, dyes, topical preparations, or processes used.

  • In the event that proper at home after-care procedures are not followed, I accept full responsibility for such complications that may arise.

  • I acknowledge that this procedure results in a long-lasting change in my appearance & accept responsibly for approving the design and color of the semi-permanent makeup being applied.

  • Skin altering procedures such as laser treatments, plastic surgery, implants and/or injections may alter & degrade semi-permanent makeup. I understand that in some cases the semi-permanent makeup may not be correctable through further procedures & such changes are not at the fault of the service provider. 

  • I consent to any relative photographs being taken before & after the procedure, as well as them being used for marketing purposes. I may also withdrawal consent at anytime by contacting Empress Aesthetics to discontinue the use of said photos.

  • I have been given the full opportunity to ask any and all questions about said procedure & my questions have been answered to my full & total satisfaction by my micropigmentation specialist.

  • I understand that additional appointments after the initial follow up may be required to achieve optimal results - this will be billed at standard rates. 

  • If you have had micropigmentation done previously by a different practitioner, it is understood that this involves additional risk because of existing pigments of unknown composition, brand, color, age, shape, & other factors in which Empress Aesthetics has no control over.

  • I further acknowledge that at the time of signing this contract - I am of sound mind & fully capable of making independent decisions for myself. 

Thank you for submitting!

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