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Consent Form (Permanent Makeup / PMU)
Studio: [Studio Name]
Artist: [Artist Name]
Client: [Client Name]
Appointment: [Appointment Date] at [Appointment Time]
Client Information
•Phone: [Client Phone]
•Email: [Client Email]
•Date of Birth: [Client Dob]
Treatment Details
•Treatment Area:
Eyebrows (microblading / shading / combination)
Lips (lip blush / lip liner / full lip)
Eyeliner (lash enhancement / classic / winged)
Other: [Treatment Area Other]
•Technique / Style: [Technique]
•Pigment Color: [Pigment Colors]
Patch Test
•Patch test completed?
Yes — Date: [Patch Test Date] — Result: [Patch Test Result]
No — Client declined or waived; client acknowledges the increased risk of allergic reaction.
I understand that a patch test reduces but does not eliminate the risk of an allergic reaction.
Expectations and Limitations
I understand that PMU is a semi-permanent to permanent procedure. Pigment will fade over time but cannot be fully removed without a medical procedure.
I understand that a follow-up touch-up appointment (typically 4–8 weeks after the initial session) is standard and may be required to achieve the desired result. Touch-ups are a separate service and may be charged separately.
I understand that color and shape may look different as healing progresses. The final result is not visible until fully healed (4–6 weeks).
I understand that minor asymmetry is a natural characteristic of human faces and that perfect symmetry cannot be guaranteed.
I understand that results vary based on skin type, lifestyle, sun exposure, and skincare products used.
I understand that periodic maintenance touch-ups (typically every 1–3 years) are needed to keep the appearance fresh.
If I have existing permanent makeup in this area: I understand that results over previous work vary and cannot be fully predicted.
Risk Acknowledgement
I understand risks include infection, scarring, allergic reactions, pigment migration, uneven fading, and hyperpigmentation or hypopigmentation.
I have been informed that PMU pigments may cause MRI image artifacts. I will inform medical staff of my PMU before undergoing an MRI.
I understand that no specific outcome can be guaranteed.
** I consent to before/after photos for the artist's portfolio and marketing use. I understand I may decline this without affecting my treatment.
Medical and Allergy Screening
•Known allergies (latex, nickel, pigments, topical anesthetics)?
Yes — describe: [Allergy Details]
No
•Are you pregnant or nursing?
Yes
No
PMU is generally not recommended during pregnancy or while nursing. Consult your healthcare provider.
•Blood-thinning medications (aspirin, warfarin, etc.)?
Yes
No
•Active skin conditions in the treatment area (eczema, psoriasis, rosacea)?
Yes — describe: [Skin Condition Details]
No
•Keloid or hypertrophic scarring history?
Yes
No
•Autoimmune conditions or immunosuppressant medications?
Yes
No
•Accutane in the past 12 months?
Yes
No
PMU is generally contraindicated within 12 months of stopping Accutane — consult your prescribing doctor.
•Chemotherapy or radiation treatment?
Yes
No
•Botox or fillers in the treatment area in the past 4 weeks?
Yes — Date of last treatment: [Botox Date]
No
Other relevant medical information::
I certify that I have answered the above questions truthfully and to the best of my knowledge.
I confirm that my decision to proceed is entirely my own, and I consent to the PMU procedure described above.
Client Signature: ______ Date: ______
Artist/Staff Signature: ______ Date: ______