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Declaration

I present to Erin Hazledine that I am over the age of 18 and desire the practitioner to perform the elective cosmetic procedure, understanding that this procedure is for cosmetic enhancement only. I am aware that no guarantees have been made to me concerning the result of the procedure. Signature: I also understand that this cosmetic procedure carries possible complications and consequences if instructions at the time of the treatment and postprocedure care are not followed. It is possible to experience the risk of infection, scarring, eye damage, inconsistent colouring, bruising and probable spreading and fading of pigment. There is a chance of corneal abrasion eye damage hospitalisation from this treatment and Erin Hazledine will not be responsible for time off work, hospital, medical bills or compensation from this. We do everything to prevent this from happening but there is a small chance that your eye may react joy and also smack her. I understand that the actual colour of the pigment maybe modified slightly due to the tone and colour of my skin. I fully understand as with all procedures that this is not a science but rather in art. I appreciate and except the varying permanency of the procedure whether it is for some months, years or forever as well as well the possible complications and consequences of the same procedure. Signature: I acknowledge the choice I've made to have cosmetic tattooing and that it is my choice only and agree to any action or conduct reasonably necessary to perform the procedure. I acknowledge that I cannot donate blood/plasma to the blood bank for the wait time they state as this procedure is classed as a tattoo. For the purpose of documentation I also consent to the taking of photographs before, during and after the procedure to document my treatment. These photos may or may not be used by the practitioner, for whatever purpose deemed necessary. I state that I understand the cosmetic procedure, and the permanency of the procedure and that the procedure is for cosmetic purposes only. I hear by authorise Erin Hazledine to perform the cosmetic procedure. Signature: I agree that I have a duty to disclose to you every matter that I know of got, that I could reasonably be expected to know :that is relevant to your decision whether to accept me as a client for the proposed cosmetic procedures. I agree that the fee is been discussed for the said cosmetic tattooing procedure and has been agreed upon. That since client approval is obtained prior to final selection of colour and design applications, I know refund policy is employed. I also agree that the cosmetic tattooing procedure is a multi session process and this may incur additional fees. I further agreed that these consent forms are confidential and remain the sole property of Erin Hazledine. Signature TOPICAL ANAESTHETIC INFORMED CONCENT I do not have any known allergies to local anaesthetic or PABA (sunscreen). I have no reason to know why I cannot receive topical anaesthetic to prevent or reduce discomfort during the procedure. I understand that there is a wide variation in effectiveness and duration of topically applied anaesthetics. I hereby request the use of topical anaesthetic preparation, which may contain lignocaine, procaine and tetracaine and understand I may experience redness, swelling or eating with the use of topical anaesthetic. I also understand and agree that complications can and do occur during a cosmetic tattoo procedure and if required will follow the instruction of my practitioner to seek treatment. I accept the use of typically applied anaesthetic at my own risk for the elective procedure. Signature: I have read the post procedure and I understand the aftercare I have to follow to maximise the benefits of my treatment and minimise complications. Signature: On the day, we sign for: ACCEPTANCE OF SHAPE I have been given the opportunity to discuss and alter the shape drawn by myself by the practitioner and certify that this is the final shape of my choice. Signature: ACCEPTANCE OF COLOUR Colours have been discussed and shown to me and the practitioner has assisted me with the selection. I hear by certify that the colours chosen are my choice. Signature: