Electronic Signature Consent

By completing and submitting this form electronically, I agree that my electronic signature and selections represent my intent to sign this consent form. I understand that my responses will be electronically submitted to Cosmetic Ink Artistry and Michelle Daniel, Owner, and retained as part of my client record.

I consent to the use of electronic records and electronic signatures.

Client Information

Treatment Information

Treatment / Procedure*
Please select a treatmentPermanent Makeup / Cosmetic TattooingMicroblading / BrowsLip BlushEyelinerFibroblast / Plasma Skin TreatmentScar or Stretch Mark TreatmentSkin Rejuvenation / TighteningOther

Area(s) Being Treated*

If you selected “Other,” please describe the treatment.

Health, Treatment & Procedure Disclosure

I confirm that I have provided complete and accurate information regarding my health history, medications, allergies, sensitivities, previous procedures, and any other condition that could affect my treatment or healing.

I confirm that the health information I have provided is accurate and complete to the best of my knowledge.

I understand the nature and purpose of the treatment I am receiving. The procedure, expected healing process, aftercare requirements, possible alternatives, and realistic expectations have been explained to me, and I have had an opportunity to ask questions.

I understand and consent to the treatment described above.

Risks & Possible Complications

I understand that cosmetic and skin procedures involve risks and that individual responses and healing results vary. Depending upon the procedure, possible risks may include temporary or prolonged redness, swelling, tenderness, bruising, discomfort, bleeding, scabbing, dryness, itching, infection, delayed healing, allergic or sensitivity reactions, pigment changes, hyperpigmentation, hypopigmentation, scarring, asymmetry, color variation, uneven results, or an unsatisfactory cosmetic result.

I understand that additional risks may apply to my specific procedure and that these risks should be discussed with my provider before treatment.

I understand and accept the potential risks and complications associated with my treatment.

I understand that previously unknown sensitivities, allergies, or complications may occur even when proper procedures and precautions are followed.

I understand that unexpected allergic or sensitivity reactions are possible.

I understand that some procedures may involve temporary pain, tenderness, or discomfort during or after treatment.

I understand that discomfort may occur.

Results & Additional Treatments

I understand that cosmetic results vary from person to person and that Cosmetic Ink Artistry cannot guarantee a specific result, outcome, color retention, symmetry, healing response, or duration of results.

I understand that touch-ups, follow-up appointments, maintenance procedures, or additional treatments may be recommended or required to achieve or maintain my desired result and may involve additional fees.

I understand that results cannot be guaranteed.

I understand that follow-up or additional procedures may be recommended and may involve additional fees.

Eligibility & Personal Responsibility

I confirm that I am at least 18 years of age unless a different age requirement and legally valid parental or guardian consent applies to the specific service being performed. I confirm that I am not currently impaired by alcohol or recreational drugs and that I am able to understand and voluntarily consent to this procedure.

I confirm that I am legally able to provide informed consent for this treatment.

I agree to immediately inform my provider of any change in my health, medications, pregnancy status, allergies, skin condition, or other circumstances that could affect the safety or outcome of my treatment.

I accept responsibility for providing accurate information and following the instructions provided to me.

Infection, Healing & Aftercare

I understand that infection and other healing complications are possible following cosmetic or skin procedures. I agree to carefully follow all pre-treatment and post-treatment instructions provided by Cosmetic Ink Artistry and to contact the studio if I experience unusual or concerning symptoms.

I understand the importance of proper aftercare and agree to follow the instructions provided to me.

I understand that sun exposure can affect healing and may increase the risk of discoloration or pigment changes following certain treatments. When applicable, I agree to use appropriate sun protection, including a broad-spectrum sunscreen as directed by my provider.

I understand and agree to follow the sun-protection recommendations for my procedure.

Patch / Spot Testing

For procedures involving pigments, topical products, adhesives, anesthetics, or other products that could cause sensitivity, I understand that patch or spot testing may be offered or recommended. I understand that a negative patch test cannot guarantee that an allergic or delayed reaction will not occur.

[radio* spot-testing use_label_element "I request a patch/spot test when applicable." "I decline a patch/spot test when optional and understand that an unexpected reaction may still occur." "Not applicable to my treatment."]

Permanent Makeup & Pigment Procedures

If my procedure involves permanent makeup, cosmetic tattooing, or pigment implantation, I understand that pigment retention and appearance can vary based on skin type, lifestyle, sun exposure, medications, skincare products, healing response, and other individual factors. Pigment may fade, change color, heal unevenly, or require additional sessions.

[radio* pigment-consent use_label_element "I understand and agree." "Not applicable to my treatment."]

Questions & Informed Consent

I have had an opportunity to ask questions regarding my treatment, the products and techniques being used, expected results, aftercare, potential risks, and possible complications. My questions have been answered to my satisfaction.

I have received sufficient information to make an informed decision about my treatment.

I confirm that I have read this consent form, or it has been read and explained to me, and I understand its contents.

I understand this consent and voluntarily agree to proceed with my selected treatment.

Aftercare Instructions

I acknowledge that treatment-specific aftercare instructions have been or will be provided to me. I understand that failure to follow aftercare instructions may affect healing and results and may increase the risk of complications.

I agree to follow the aftercare instructions provided for my treatment.

Release & Acknowledgment

I understand that cosmetic procedures involve inherent risks and that results cannot be guaranteed. I voluntarily choose to receive the treatment identified above after having the opportunity to review the information provided and ask questions.

To the extent permitted by applicable law, I acknowledge and accept the ordinary and disclosed risks associated with my voluntary treatment. Nothing in this consent is intended to waive rights that cannot legally be waived.

I acknowledge the disclosed risks and voluntarily consent to treatment.

Final Consent

I confirm that the information I have provided is truthful and complete. I understand the nature of my selected treatment, its potential risks, expected healing process, aftercare requirements, and the fact that results vary between individuals.

I have had sufficient time to review this information and ask questions. I voluntarily authorize Cosmetic Ink Artistry and its qualified provider(s) to perform the treatment identified on this form.

I have read and understand this consent form and voluntarily agree to proceed.