TemplateCopy and customize for your shop
Consent Form (Saline Tattoo Removal)
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
Lips
Small body tattoo
Other: [Treatment Area Other]
•Goal:
Lighten before new PMU
Correct shape or color
Full removal
•Solution Used: [Solution Type]
•Previous Removal Treatments on This Area: [Prior Removal Details]
How It Works
I understand saline removal uses a tattoo device to work a saline-based solution into the tattooed skin. Some pigment lifts out as the skin heals and forms a scab. This is not a laser treatment.
Expectations
I understand I'll likely need multiple sessions, spaced weeks apart so my skin can fully heal. My artist will tell me how long to wait.
I understand results vary and full removal is not guaranteed. Some pigment may remain.
I understand the area may look worse before it looks better. It may look red, dark, or uneven while it heals.
If I plan new PMU over this area, I'll wait until my skin has fully healed and my artist says it's ready.
I understand sessions are billed according to studio policy, and payment doesn't depend on how fast or how fully the pigment clears.
Scab Care
I understand a scab will form and must fall off on its own. Picking or peeling it can pull pigment out unevenly and raise the risk of scarring.
I will keep the area clean and dry as directed, and follow the aftercare instructions exactly.
I won't put makeup, creams, or other products on the area until it heals, unless my artist says it's okay.
Risk Acknowledgement
I understand risks include redness, swelling, oozing, scabbing, infection, scarring, changes in skin texture, and lighter or darker skin color.
I understand the risk of scarring is higher if I pick the scab, have a history of keloids, or treat the same area again too soon.
I consent to photos of the treatment area for my treatment record.
** I consent to before and after photos for marketing. I can say no without it affecting my treatment.
Medical Screening
•Keloid or raised scarring history?
Yes
No
•Accutane in the past 12 months?
Yes
No
Ask your prescribing doctor before booking.
•Blood-thinning medications or bleeding disorder?
Yes
No
Don't stop a prescribed medication without talking to your doctor.
•Pregnant or nursing?
Yes
No
Talk to your healthcare provider before booking.
•Diabetes, slow healing, or immune conditions?
Yes
No
•Rash, infection, or skin condition in the treatment area?
Yes, describe: [Skin Condition Details]
No
•Botox or fillers in the treatment area in the past 4 weeks?
Yes. Date of last treatment: [Botox Date]
No
•Known allergies (latex, topical numbing creams, other)?
Yes, describe: [Allergy Details]
No
Other relevant medical information::
I certify that I have answered these questions truthfully and to the best of my knowledge.
My decision to get saline removal is my own, and I consent to the treatment described above.
Client Signature: ______ Date: ______
Artist/Staff Signature: ______ Date: ______