Free Permanent Makeup Release Form Template
Permanent Makeup Release Form
Please fill out the following release form with the correct information.
Client Information
Name
Date of Birth
Address
Phone number
Procedure Information
Type of Permanent Makeup Procedure
Area(s) to be Treated
Date of Procedure
Health & Medical History
Do you have any allergies to makeup, pigments, or other materials used in permanent makeup procedures?
Do you have any medical conditions?
Are you on any medication, including blood thinners?
Informed Consent
I, the undersigned, consent to the application of permanent makeup procedures to the areas specified above. I understand that permanent makeup involves the use of needles and ink to apply pigments to the skin and that the procedure is considered permanent.
Date:
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